- Cofield: "Do you have any questions before we get started?"
- House: "Yeah. Who the hell are you?"
- Cofield: "I'm Walter Cofield. Chief of Neurology, Mercy Hospital. I'll be deciding your fate today."
- — Nobody's Fault
After a patient suffers a psychotic break and nearly kills a hospital staff member while being treated for by House, House's career and freedom are in jeopardy and his fate is in the hands of New York Mercy Hospital's head of neurology Dr. Walter Cofield - a famous neurosurgeon who was once Foreman's mentor. However, the question becomes whether the fault was in House's unorthodox methods or the behavior of the other treating physicians. In the end, Dr. Cofield must balance House's results against the dangers of his methods and determine whether House must be stopped. The outcome is far from clear when House's most loyal fellow comes to believe that the boss is the one to blame.
The format of the episode was similar to The Mistake, where the case will unfold during the investigation. It will also follow the format of Three Stories and Two Stories by telling the story in non-chronological fashion.
Reviews of the episode touted it as one of the most important episodes of the series.
We see a devastated hospital room. Blood is splattered everywhere.
House stares in a mirror, then washes his face to refresh himself. He walks down a hall and enters a small room where someone is waiting for him. The man starts a recording device and announces he’s convening a disciplinary hearing. He advises House that the recording will be transcribed and published. He asks if House has any questions. House asks who the man is. He say he is Walter Cofield, the chief of neurology at Mercy Hospital, and he will be deciding House’s fate.
House has heard of Cofield and realizes he trained Foreman when Foreman was at Hopkins. However, when House discusses it, Cofield realizes he’s deflecting and turns back to the subject matter at hand. House says he’s already written down a statement and gets up to go back to work. Cofield warns him that if he wants to rely on what’s written down, that information is not in his favor. He would have to suspend House, which would mean House would go back to jail. House sits back down again.
House starts describing the patient, a chemistry teacher who collapsed while jogging. Forman brought the case to him. He claims Foreman was stumped and begged for help. He then admits he may have been exaggerating. House takes a Vicodin and Cofield asks if he has had recent surgery. House admits it was ten years ago. He also admits to taking Vicodin during the case, and for most of the last nine years before that. He defends himself with his record. Cofield counters that when bad things happen, people should learn from their mistakes. House thinks its all about assigning blame, even though bad things happen for no reason all the time.
We see House presenting the case to his team. Adams describes House’s flippant attitude and claims she isn’t trying to make him look bad. She says she doesn’t think it was Houses’ fault.
Taub thought it was a liver problem. Park tells Cofield that House thought Taub’s idea was stupid. Park thought it was normal pressure hydrocephalus. House says he thought Park’s idea was stupid and thinks Cofield should know why. Cofield goes over the results of the lumbar puncture which did rule out Park’s hypothesis. He admits to putting down Park with an ethnic insult. When Cofield asks if that’s what he wants on the record, House repeats the insult slowly and clearly. Instead, House realized Chase was right about the patient’s potassium being off and House went with thyrotoxic paralysis. House ordered steroids, PTU and beta blockers. Cofield asks how orange smudges got on the chart and House admits he was eating Cheetos and wonders why it’s relevant. Cofield presses the point and House admits that he pranked Chase by putting orange hair dye in his shampoo.
However, Adams says the prank was House’s standard method - creating chaos within the team. However, she admits that it gets the team to come up with better ideas because they compete with each other. In addition, the steroids helped - the patient regained consciousness and was responsive. He passed the initial cognitive tests and they started a physical examination. A couple of students came in to visit and mentioned an explosion, catching Taub and Adams off guard. Taub explained it was a chemistry experiment gone wrong and it wasn’t in the chart until after the patient regained consciousness. He also explained that although he had spoken to the wife, she didn’t know about the explosion either. Taub explains that although House thinks a medical history is crucial, he doesn’t think being in the same room as patients and family is necessary. House thinks it allows him to be more objective. Taub agrees with House on the point.
House admits to being lazy. He also says if you want an accurate history, talking to the patient is the wrong way to go because everybody lies. He corrects himself by saying he wouldn’t lie to Cofield. Cofield asks House if he had been more involved might not the case have ended differently.
However, the patient denied it was an explosion. However, the students have another story, including a video that was posted to YouTube. The patient then starts coughing up blood. House admits he got more intrigued at that point.
They watch the explosion on YouTube. The patient explained the student who helped set it up put in too much of one of the chemicals. Adams tells Cofield the student was just trying to make a good video and didn’t intend to hurt anyone. They figure the extra hydrofluoric acid in the experiment burned the patient’s lungs. Park puts the unconsciousness down to a brain stem injury at the same moment that was delayed until the swelling got worse. Cofield starts to realize she’s hiding something. Park admits that House wore a gas mask and had a stink bomb that Chase had planted in his office, except House found it before it went off and went to teach his fellows a lesson. He wouldn’t let them out of the room until they come up with a way of treating the acid burns inside the lung. Taub finally suggests aerosolized heparin, an experimental treatment only used in sheep. House likes the idea and goes with it. House defends both the treatment for a rapidly deteriorating patient and the stink bomb. Cofield accuses House of using manipulation to get his team to come up with unsafe ideas. House says if they had used safe ideas, the patient would have died.
Park says she did tell House it was an insane idea. Cofield chides her for not standing up to House. Park says she did what she could, then went to Foreman. However, Foreman realized that House wouldn’t be trying it unless there was no other way to help the patient.
Cofield meets with Foreman and asks why he didn’t tell him he was involved in the case. Foreman reminds him that the use of heparin had no effect on the outcome of the case. Cofield says that by enabling House, Foreman is giving the message to House’s team that he can’t be stopped. Foreman says that House is brilliant and he gives him the benefit of the doubt, because he’s seen House get results. Cofield realizes if House goes back to prison, Foreman loses his job as Dean of Medicine. Foreman agrees that’s probably the case. Cofield realizes that he was chosen because he might give Foreman the benefit of the doubt. However, Cofield tells Foreman it’s not his job to get Foreman out of a bad spot.
The patient improved rapidly and was ready to be discharged. However, House ordered a bath to ensure that there was no chemical residue on the patient’s skin. However, during the bath, they found a rash. The patient got upset and said he wanted out of the hospital. Park thought the rash was nothing more than irritation from his bed sheets. She thought the real problem was that the patient started freaking out about it. However, Adams thought the rash might be streptococcus and wanted to make sure. She dismissed the brain issues. However, Park was afraid it was psychosis induced by the steroids he received. On the other hand, Taub was sure it was Wegener’s disease. Faced with three different possible diagnoses, House decided to give the patient high-dose steroids. The patient’s reaction would show which one was right. Cofield points out that in two out of three possibilities, the patient gets worse. House pointed out that not having a diagnosis was making the patient worse and this was the fastest path. Cofield asks House to review his decision in hindsight. House still thinks it was the right decision - the problem was that his own team disobeyed his orders.
Chase thought Adams was right and went to do a biopsy of the rash. Adams says she thought it was a good idea. However, when Adams went to give the patient lidocaine, he lashed out at her. Chase went to restrain him. He and the patient struggled and Adams called a code grey. Cofield asks since Adams and Chase both disobeyed him, who he blamed. House doesn’t answer.
Taub rushes to help, as do two orderlies. Taub manages to sedate the patient, but Chase has been badly injured - stabbed with the biopsy scalpel. He collapses. Taub and Adams start first aid, but the scalpel has hit the heart. Adams reports that, luckily, Chase’s heart was not pierced, only lacerated. However, at the time, the only thing keeping him alive was Adams keeping her finger in the hole created by the scalpel. She blames herself.
They rush Chase to the operating room.
House points out that the diagnostic test proved him (and Park) right. The patient had steroid induced psychosis. Cofield wonders why he didn’t care about Chase.
However, House joins the team in the operating room. Adams is afraid to remove her finger, but House points out Chase’s O2 stats are optimal - there’s no better time. Taub prepares to suture the wound. It goes well. House goes back to the other patient. He calls Park out to do a differential. She wants to stay with Chase. House reminds Park he listened to her - it was Chase who didn’t listen to him and that her being there doesn’t help Chase or the patient. When she refuses, House leaves.
Cofield thinks House was callous, but Taub agrees there was nothing House could have done for Chase. Cofield asks Taub to think what would have happened if he was in the room and Taub says he wouldn’t have been. Cofield asks Taub it he’s blaming Chase. Taub points out that they knew a psychotic episode was a possibility and Chase was the one who brought a scalpel into the room.
House goes to the patient’s room to get the patient’s EKG. He goes to his team to tell them the patient has excessive R-R variability. Chase is lying unconscious. House tells them to focus on their real patient because there’s nothing they can do for Chase. When House continues, Adams tells him to shut up. Chase finally regains consciousness and complains he can’t feel his legs.
Cofield goes to see Chase in his hospital bed. Cofield wonders why Chase doesn’t have orange hair anymore, and Chase says he dyed it back. Cofield asks if he was angry at House about the prank. Chase wonders why it’s relevant unless Cofield figures his judgment was compromised. Chase says the accident wasn’t anyone’s fault, and although he was angry, he wasn’t distracted. He tells Cofield that if he ever walks again, it will be because of House.
When House learned Chase was paralyzed, he starts a differential - there’s no reason why Chase’s legs should be affected. Even Chase gets in on the differential, but if he’s right, the damage is permanent. House rejects the idea. He hits on the idea of a clot blocking blood flow to the legs. He wants to do more surgery to remove an embolism .
They start the procedure on Chase and find the clot. Taub starts to remove it, but House comes in to do a differential on the other patient again. Foreman is trying to transfer that patient to Princeton General because House’s team is too distracted. Cofield asks Chase if that wasn’t callous. However, Chase says that House just wanted to check on how Chase was doing without letting his team know that he cared. House knew going in they would ignore him. Cofield doesn’t believe it. However, it appears Chase has regained feeling in his legs. Cofield asks why Chase ignored the risk of the psychosis. Chase says he thought he was right about the rash and says he would do it again. When Cofield says that’s what he thought, Chase asks him what he means. Cofield says either House allows his team to defy him, that Chase was distracted, or that House’s method of diagnosis is a game and Chase wanted to win. He says Chase may never walk again because House creates a reckless atmosphere.
Cofield starts his last interview with House. House didn’t know Chase had regained feeling in his legs. Cofield turns off the recorder and asks if House is really that indifferent. House wants to know if Cofield wants to hit him. They argue about whether House should at least apologize to Chase. To defy Cofield about his lack of manners, House puts his feet on the table. Cofield says he wants to know how House’s mind works. House just wants to get through the interview. Cofield tells House to put the Vicodin away. House says his leg hurts, but when he opens the Vicodin bottle, it explodes. Cofield isn’t the culprit and isn’t amused, but the explosion gets House thinking. He runs out of the room in spite of Cofield’s protests.
House goes to see the patient in the ambulance before he is transferred. The ambulance driver tells House that the patient isn’t his anymore and drives away. House finds the patient’s wife and tells her that her husband has a tumor in his lymph nodes. When the explosion happened, it ruptured the tumor and flooded his body with debris, causing all his symptoms. The psychosis was all the fault of the doctors giving him steroids. He tells her her husband needs radiation therapy and plasmapheresis. However, he realizes she doesn’t believe him.
House goes back to see Cofield, but he’s left. Foreman tells him Cofield’s decision will be ready the next day.
Chase is in his bed, but can’t sleep. Foreman is similarly awake in his office. Cofield is pulling an all-nighter. When Chase falls asleep, House goes to visit him.
The next morning, House shows up in the interview room early. Foreman and the team arrive as well. Cofield finally arrives. Cofield admits he didn’t sleep. He calls House brilliant, but a fiasco. He says if he exonerates him, he sends a message to the rest of the staff that it’s fine if they act the same way. However, as Cofield tries to continue, the patient’s wife arrives looking for House. She knows what’s going on. She says House isn’t nice, but House was right about the tumor. They expect the husband to make a full recovery. She thanks Dr. House and leaves. Cofield finally continues. He calls House dangerous and inappropriate, but admits he’s effective. He realizes that he will only hurt the hospital if he changes House’s process. He says that the stabbing was nobody’s fault. As he goes to leave, House calls him a coward. He notes Cofield has twenty pages of notes he was obviously planning to read. House takes the folder and finds a parole form in it. He realizes Cofield was going to send him back to prison. House reminds him that a good outcome in the case doesn’t affect whether House did the right thing or not. House leaves.
House goes to the physical therapy room to see Chase. He asks how Chase managed to rig his Vicodin bottle. Chase asks why he dyed his hair orange. House admits that he knew Chase had used Adams’ shampoo, but wasn’t having sex with Adams. He realized Chase was coming to the hospital late because he had been boozing and wanted to teach him to come in on time. He tells Chase that Cofield has ruled the stabbing was nobody’s fault. House admits that Cofield was wrong and apologizes. Chase says he’s busy and asks if House has anything else to say. House says he’s done. Chase gets back to his rehab.
- Chase is stabbed by a patient and is left permanently disabled.
- There is an investigation into House’s conduct during the case, but he is vindicated.
Zebra Factor 2/10Edit
Lymph node tumors are a common type of cancer, and tumor lysis syndrome is a common complication.
Trivia & Cultural ReferencesEdit
- Cheetos are the most popular cheese flavored corn snacks in the United States.
- YouTube is the world’s most popular video sharing site.
- Robert Sean Leonard (James Wilson) does not appear in this episode and his name isn't seen in the opening credits.
- The opening sequence is not shown in this episode.
- Episode page at IMDB
- Episode review at Blogcritics
- Episode article at Wikipedia
- Episode page at House MD Guide
- Episode transcript at Clinic Duty
- A review of the medicine at Polite Dissent
- Episode review at Lena Lamoray.com
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