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Mirrored Confession

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Mirrored Confession is case #11 in House M.D. - Critical Cases.

Oliver Riggs, a troublesome 17 year old high-school student, it brought to the emergency room after a coughing spell which resulted in him collapsing from a seizure.  Although the case was assigned to Gregory House, he showed no interest in it and told his team that he would not continue on the case unless they could find a reason to get him interested in it.

The team started with an environmental scan, where they recovered a pair of boots.  After using 1 ward favor, 16 head meds and one roll of gauze, they detected high levels of ammonia on the boots.  As Oliver lived in a rural area, they felt his symptoms were more likely due to a chemical exposure which would rule out a viral cause such as encephalitis.

The team does another environmental scan, this time with flashlights.  They discover a stereo system with the volume set to very high.  After using 2 ward favors, 2 syringes and 16 chem meds, they talk to Oliver's parents and find out he has been playing this stereo very loud for the past few weeks.  The team realizes there are only two possibilities - Oliver is trying to cover up other noises in his room, or he is suffering hearing loss.  Either way, this would rule out heavy metal poisoning as this only causes short term hearing loss.

The team does another environmental scan comparing silhouettes and find a syringe.  After using 1 ward favor, $750 of budget and 16 body meds, they find no sign of drugs on it.  This appears to rule out the possibility of narcotic abuse.

Given that it is more likely on the evidence and that the farm Oliver lives on has access to numerous industrial chemicals, Eric Foreman decides to treat the patient for chemical poisoning with 2 oxygen masks, 2 ward favors and 18 gland meds.  However, Oliver doesn't improve.  House checks in on him and Oliver denies using any kind of drugs and feels the "crippled old man" can't be of any help.  House decides to leave and when Chris Taub and Thirteen realize that Oliver is running a fever of 104F, it doesn't change House's mind.

Oliver goes code blue and has to be defibrilated

House orders imaging which shows generalized swelling.  After using 12 chem meds and 4 IV bags, the team realize that the swelling rules out fibromyalgia.

A further round of imaging shows scar tissue from a childhood operation to insert tubes in the ears to prevent infection.  After using 16 head meds, 1 ward favor and $700 of budget, they realize the hearing loss has to be from an external cause which rules out adrenoleukodystrophy.

More imaging shows that there is a buildup of fluid underneath the outer lining of the brain, which would allow bacterial infections.  After using 18 heart meds and 2 thermometers, they can rule out infectious mononucleosis as it's caused by a virus.

They decide to treat Oliver for bacterial meningitis with 16 digestive meds, 2 ward favors and 2 syringes.  However, when they next go to check up on him, he has gone missing.  However, Foreman realizes that Oliver is probably after House's Vicodin and House realizes his is missing.  They find Oliver in the lobby.  He is conscious and his pupils are responsive to stimuli, but suddenly he starts growling at the doctors.

Oliver goes code blue again and once again has to be defibrilated.

With meningitis ruled out, House orders a blood analysis.  It shows that his blood oxygen level is low, but they can't find any blockage that would explain that.  The only possibility seems to be that he is having trouble breathing due to muscle spasms.  After using 20 chem meds and 4 oxygen masks, they realize the lack of blockage rules out ischemic stroke.

A further blood analysis shows very low sodium levels.  After using 1 ward favor and 20 head meds, they realize that this problem isn't caused by malfunctioning kidneys and they can rule out chronic kidney disease.

The team runs another round of blood analysis.  After using 3 oxygen masks, 2 ward favours and $750 of the budget, they find traces of a hepatitis C infection, most likely from injecting drugs.  Given that Oliver is injecting, he is unlikely to be huffing chemicals as well and they rule out inhalant intoxication.

Oliver is treated for tetanus with 4 gauze, 20 heart meds, $800 of budget and 3 ward favors and starts to improve.  His parents resist treatment as House claims that Oliver was sneaking out of his house at night to steal and deal in drugs.  It's the only explanation for how he could become infected and also explains why a teenager on an allowance has over $7,000 worth of electronics and musical instruments in his room.  However, Foreman manages to convince the parents that they can't be naive about Oliver's behavior and they agree to treatment.

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