Robert Elliot a.k.a. Mr. X is the John Doe patient in the episode Mirror Mirror after being mugged. He starts mimicking the personalities of the doctors who treat him and is soon dubbed the "Mirror Patient". He is portrayed by actor Frank Whaley.
Case History[]
The patient was admitted when he was discovered after a 911 call alone on the street on his hands and knees coughing uncontrollably in respiratory distress. He had no identification.
The emergency room could find no underlying cause for the respiratory distress, but it soon spontaneously resolved itself, and the patient identified himself as Martin Harris. The case was assigned to Dr. House. Dr. Cole thought it might be asthma, but there was no hyperinflation on the X-ray. Dr. Kutner suggested an allergic reaction to shellfish or peanuts, but the patient had no hives or erythema on the skin. Dr. Volakis suggested an embolism, but an embolism can't resolve spontaneously. Dr. Foreman suggested a laryngospasm from inhaling cold air. Dr. House determined the only way to diagnose the condition was to try to replicate the respiratory distress and ordered a methacholine challenge.
Dr. Volakis and Dr. Brennan ran the methacholine challenge. The patient started to complain his foot was tingling and he had severe stomach pain. The patient asked if the test could cause those symptoms and Dr. Volakis answered that it could not.
Dr. Foreman ran a new differential diagnosis with the remaining doctors. Dr. Brennan suggested an aortic dissection from an aneurysm, but it wouldn't account for all the symptoms. Dr. Taub suggested a spinal cord lesion, but Dr. Foreman pointed out it would have to be in the brainstem, and it still wouldn't explain the respiratory collapse. Dr. Foreman suggested multiple marantic emboli, but at that moment, the patient started to crash and they were paged.
They found the patient in the hallway collapsed, but with a pulse. Dr. Kutner realized that they could use this opportunity to see if it was a laryngospasm, but Dr. Volakis said he had to be intubated and treated with an ambu bag. Dr. Kutner agreed, but asked for a moment before they started and grabbed an endoscope and asked for assistance in straightening out the patient's throat to make it easier. Dr. Foreman observed the patient and suggested he had Munchausen syndrome. He pointed out the name of the patient was the same as the EMT tech that brought him in. He also pointed out that the patient's symptoms exactly matched those of his neighbors. However, Dr. House pointed out that Munchausen's patients can create their own symptoms and generally don't fake their names. Dr. Foreman supposed that the patient didn't want them to find a previous medical history under his own name. Dr. Taub informed them that the patient had no laryngospasm, and Dr. Hadley reported the patient was now breathing normally without treatment. Dr. Foreman believed that this showed the patient was faking, but Dr. House wondered why the patient was wearing a lab coat, pretending to be a doctor, when Munchausen's patients want to be treated as patients. He suggested that the patient had Giovannini Mirror Syndrome, a rare symptom where the frontal lobe is suppressed and the patient acts like the people around him because he has no memories or personality of his own. If that were the case, the patient would have to have brain damage. Dr. House realized there was a quick way to check.
Dr. House brought the patient into an operating room during a procedure and asked him what was going on. "Martin" realized it was an operation. Dr. House then asked the patient who he was, and the patient walked over to the operating table and started talking like Dr. Wilson, the surgeon. He then picked up a scalpel. When Dr. House grabbed the patient's hand to stop him, the noticed a strange pattern of blood vessels on the surface of his skin. He used the scalpel to cut the patient, and the blood only oozed out instead of flowing. He realized the patient need to be heating to get his blood flowing again. He reminded Dr. Foreman that this was a symptom that was impossible to fake.
Dr. House reminded his team that mirror syndrome patients have an uncanny ability to read people. It was obvious that the cold temperature in the operating room caused the agglutination of the blood. Dr. Volakis realized that this pointed to an infection, but Dr. Cole pointed out that if the infection wasn't causing a fever, it would be small and hard to find. Dr. Kutner suggested running blood cultures, but given the consistency of the patient's blood, cultures were impossible. Dr. Kutner suggested soaking the patient in warm water before they drew the blood. Dr. Taub suggested running an ultrasound on his abdomen to look for an abscess. Dr. Cole realized they had to do an environmental scan to get a better medical history, but Dr. Brennan pointed out that they had already checked missing persons and found no one matching the patient's description. However, Dr. House realized that the patient came in with a car key. He ordered the patient be isolated and ordered the blood draws, ultrasound, and a search for the car. Dr. Cole and Dr. Hadley went to look for the car.
The patient was put in heating blankets instead of hot water and Dr. Volakis was successfully able to draw his blood. Dr. Taub performed the ultrasound. He didn't find an abcess, but found a lesion on the patient's liver. Dr. House went to get his team, but found out they had all been assigned to clinic duty because of a food poisoning scare in the cafeteria. Dr. House found his team members. Dr. Volakis suggested a biopsy of the lesion, but Dr. Kutner thought it still might be an abcess. However, Dr. Brennan pointed out if it was a vascular hemangioma, sticking a needle in it would cause him to bleed to death. Dr. House thought it was worth taking the risk of a biopsy.
Dr. Brennan performed the biopsy. He drew out a dark black fluid that appeared to be pus from a fungus. That would explain both the agglutination and memory loss. Dr. Volakis started him on amphotericin. If they were right, the patient would improve within an hour.
However, the agglutination soon spread despite the heating blankets. The patient was put in a hot whirlpool, which seemed to reverse the agglutination. The tests on the biopsy showed it wasn't fungus or even pus, just coagulated blood. Dr. Foreman pointed out the broad spectrum antibiotics weren't working, meaning it was either a virus or an exotic bacteria. Dr. Kutner wanted to redo the blood cultures, but Dr. House thought getting a better medical history was the next best step and called Dr. Cole and Dr. Hadley to check their progress, but they found the car in an unattended impound lot guarded by Dobermans. Instead of running new blood cultures, Dr. House decided to run antibody tests to find out what diseases the patient had in the past to determine if they would point to a specific location. He ordered a draw of the patient's blood and cerebrospinal fluid for testing.
The patient tested positive for histoplasmosis, showing he had lived in the Ohio River Valley, and coccidioidomycosis, which is common in the San Joachin Valley. He was also positive for Chagas disease, which is endemic to Central America. Dr. Kutner came to report that the patient's agglutinate rash had returned despite the hot tub. Dr. House ordered lipopolysaccharide to raise the patient's body temperature. Dr. Foreman pointed out that this could raise the patient's body temperature to 110°F, destroying the brain. However, when Dr. Cuddy found out, she initially objected, but finally agreed.
Dr. Foreman administered the lipopolysaccharide. However, the patient soon suffered a cardiac arrest. They removed him from the hot tub and dried him off, but Dr. Kutner insisted on using the defibrillator as soon as possible. The shock revived the patient back to normal sinus rhythm, but the water transferred the shock to Dr. Kutner, knocking him unconscious.
The blood cultures were still negative, but Dr. House ordered them run again with a quadruple run time. However, Dr. Foreman suggested a shortcut - a heart biopsy. They knew the infection was in his heart and polys would indicate a bacterial infection, while lymphs would indicate a viral disease. Dr. Brennan noted that a heart biopsy right after a heart attack was very dangerous, but Dr. House agreed that it was the best idea they had.
Dr. Cole and Dr. Brennan returned. The patient was identified as Robert Elliott, from Hamilton, Ohio. They returned with the contents of his trunk and glove box. However, about all that was in the car was some mentholated rub and receipts. Dr. House still planned to do the biopsy and ordered Dr. Hadley to do it, relieving Dr. Foreman. The patient's agglutination rash had returned, and Dr. House ordered the drip of lipopolysaccharide be increased. Dr. Hadley completed the biopsy without incident, but it was negative. The patient was running a fever of 106 F but still had agglutination. Dr. Kutner suggested they put him back in the hot tub. When Dr. House okayed the request, Dr. Kutner remarked that the patient loved hot tubs. Dr. House said the patient must have been mimicking Dr. Kutner when he said that, but Dr. Kutner said he didn't like hot tubs. Dr. House realized it must have been the patient's real personality coming through and admonished Dr. Kutner for not mentioning it. Dr. House realized that it might be possible to get through to the patient.
Dr. House dressed in the patient's clothes and introduced himself to the patient as Robert Elliott from Hamilton, Ohio. They started talking and the patient admitted he was in New Jersey to work. The agglutination started to return despite the patient having a fever of 107°F. Dr. House started going through the restaurant receipts they found. The patient said he remembered those places, but they were more convenient than good because they were on the road. Dr. House pulled out the mentholated rub and asked the patient how he used it. The patient put some on his nostrils and breathed deeply. When asked why, the patient said that the rub didn't smell like dung. He said he didn't like the smell, but it didn't smell like dung, but dung did.
Dr. House realized the patient was around manure all the time because he sold farm equipment. The most likely infection that causes the patient's symptoms was eperythrozoon. Dr. Hadley went to start him on clarithromycin. The patient quickly improved.