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The patient’s hyperthemesia allows her to remember every detail of her life since she entered puberty. This condition is very rare with less than ten reported cases.
The patient has recently lost weight on a vegan diet.
Nadia was at work when she suddenly lost her balance. The people who aided her noticed lacerations on her legs and she complained she couldn’t move them.
At the Princeton-Plainsboro Teaching Hospital emergency room, she presented with temporary paralysis and her tests showed high creatine kinase levels. The MRI showed no evidence of a stroke or tumor. Dr. House was intrigued by the patient’s memory ability and agreed to take her case. When he presented the symptoms, Dr. Foreman couldn’t see that there could be any link between her memory and her current symptoms as they exhibited twenty years apart. Moreover, there is no known condition that can improve memory - a disease can only make memory worse. He thought it was a toxin. Dr. Taub thought she may have been exposed to botulism or had alcoholism. Dr. House ordered an environmental scan and a medical history.
Dr. Foreman and Dr. Taub performed the environmental scan. Dr. Foreman found laxatives which indicated a reason for the patient’s recent weight loss and pointed to magnesium poisoning. Dr. Taub wanted to push fluids - the magnesium would be removed in her urine. However, Dr. House rejected the theory because her heart rate and blood pressure were normal.
Ms. Masters and Dr. Chase took the medical history. The patient didn’t appear to drink much. Dr. House came in to ask Nadia about her constipation. He also wanted to know if she had been more clumsy than usual. She reported eleven trips, stumbles and falls in 2008, twelve in 2009, and twenty in 2010. Dr. House thought it was early onset Parkinson’s disease and ordered L-Dopa.
Ms. Masters tested Nadia’s muscle strength. The patient was afraid that she would either lose her memory because of Parkinson’s, or that she had cancer. Nadia’s sister Elena came to visit her, but Nadia got angry because she brought daisies, which she hates. She then started complaining about her heart. Dr. Foreman realized she had a fast wide-complex rhythm and instructed Ms. Masters to get the defibrillator.
The heart involvement ruled out Parkinson’s. They added arythmia to the list of symptoms. Dr. Chase thought the arhythmia was set off by excess catecholamine, but her normal blood pressure ruled out a pheochromocytoma. Ms. Masters thought the heart might be the main problem - a malfunctioning heart would starve the muscles of oxygen and affect coordination. The heart problems started when the patient was under stress from seeing her sister, and that could indicate Long QT syndrome. Dr. House wanted to run a stress test, but because of the patient’s stitches, she couldn’t use the treadmill. Dr. Chase suggested drug induced stress, but Dr. House said to just put Elena back in the room.
Elena apologized about the daisies to Nadia, but although there was tension, Nadia showed no adverse reaction during the nuclear study. Dr. Chase suggested that Ms. Masters try to start a fight. She went in to talk about an automobile accident where Elena ran into Nadia. They started fighting and Nadia had an adverse reaction. When Elena wouldn’t leave, Nadia told her to get out. However, the test was successful.
Nadia was put on beta blockers to control the arythmia. However, Elena was angry that Ms. Masters had tricked them into having a fight and left. Nadia’s breath then started smelling of ammonia, pointing to kidney failure.
The failing kidney’s pointed to the heart problems being a symptom, not the underlying problem. Dr. Chase wondered if the patient switched to a vegan diet because she didn’t like the tastes of proteins anymore, possibly indicating amyloidosis. However, heart stiffness would have shown up on the nuclear study if she had amyloidosis. Ms. Masters thought it was an autoimmune condition. They cause multiple organ failure and paralysis. Guillain-Barre syndrome, polymyositis, multiple sclerosis and polyarteritis nodosa would fit. Dr. House ordered steroids and dialysis.
Dr. Chase started the treatment. Nadia started to explain why she was always so angry with Elena - she remembered that the bad things always outweighed the goods. She then said she had trouble breathing.
The respiratory distress ruled out an autoimmune condition. Ms. Masters thought it was pulmonary edema related to the kidney failure. However, Dr. House noted hives on the patient’s legs. She appeared to be having an allergic reaction despite being on steroids. However, Dr. House grabbed one of the filters they used in dialysis and rubbed it against Nadia’s arm. She immediately broke out in a rash. She was allergic to the dialysis equipment. Without dialysis, she would most likely die.
Nadia’s only hope was a kidney transplant, but the transplant committee would never agree to a transplant to a patient with no diagnosis. Ms. Masters suggested a family member, but Elena was the only possibility. Dr. House asked Ms. Masters to approach Elena because she was the one who caused the current rift.
Ms. Masters went to see Elena, and Elena agreed to the transplant. Dr. Chase broke the news to the patient.
The transplant surgery went well for both Nadia and Elena. However, when Nadia started to regain consciousness, she had a seizure. Dr. Chase ordered 3mg of lorazepam and suction. Nadia lost her vital signs.
The seizure indicated the steroids weren’t working, and the tests for autoimmune conditions all came back negative. Dr. Chase thought it might be porphyria, but the patient had no abdominal pain. Dr. House wanted to know if Nadia had thanked Elena. Dr. Chase said she hasn’t yet. Dr. House told them to put Elena and Nadia together to see if Nadia would thank her. Since the patient claimed to make a perfect count of good and bad experiences, he thought that a kidney transplant would more than make up for anything bad. Dr. Chase thought the problem might be clots hitting her heart, lungs, kidney and brain. Dr. House ordered a test for Factor V Leiden because it was the easiest condition to treat. However, he also insisted that they check to see if Nadia would thank Elena.
Nadia was being treated for Factor V Leiden, but wasn’t feeling better. She asked to see her sister. However, when she was taken to see her, she thanked her and started talking about good experiences, but still became very upset with her. Dr. Chase realized that Nadia had isolated herself from friends and family because she was incapable of forgiving things she couldn’t forget. He then noticed that Nadia had developed chorea. This ruled out Factor V Leiden.
The team was stuck for new ideas, but when Dr. Foreman mentioned the patient had a lot of jigsaw puzzles in her home, Dr. House ordered a peripheral blood smear to look for acanthocytes. Dr. House went to see the patient to ask about the jigsaw puzzles. She said she never left one unfinished, and when Dr. House kept moving her water cup, she kept moving it back to the same spot. Dr. House believed these were signs of Obsessive-Compulsive Disorder. Her autobiographical memory was another presentation - she was hoarding memories. Together with her other symptoms, this indicated McLeod syndrome. It wasn’t curable, but the symptoms could be treated with medication. Unfortunately, the prognosis was not good. She looked at a maximum lifespan of another twenty years.
Nadia slowly started to feel better. Dr. Chase offered her SSRIs for her OCD. He told her that it would merely make her memory more like everyone else’s. Nadia felt her memory made her special. Dr. Chase countered that to be special, she had to be alone. He left the pills with her. She eventually decided to take them.