Paternity
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Paternity is a 1st season episode of House which first aired on November 23, 2004.
A 16-year-old boy comes to the hospital complaining of double vision and night terrors after being hit in the head by a lacrosse stick. House is dismissive until he notices a myoclonic jerk in the boy's foot. After a near-fatal hallucination and several faulty diagnoses, House is mystified . . . until he learns the boy's true paternity.
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[edit] Recap
A lacrosse player, Dan, starts suffering from double vision while playing in a game. When he is checked by another player, he falls to the ground and there is blood all over his face.
House is reading gossip magazines in the clinic when Wilson finds him in an exam room. House has five minutes until he can leave. He doesn't want to treat someone who will take half an hour to pamper. Wilson is incredulous that House and his team have no cases. Cameron is answering mail while Chase does a crossword puzzle with help from Foreman.
When House tries to leave, he finds a man with a letter, addressed from House, that says he would take his son's case. House goes to confront Cameron about it. She starts describing the case and House gets interested in the patient's night terrors. He agrees to see the family, against his usual procedure. He examines the patient, who is barely sleeping. The patient can't name any animals starting with the letter B. House thinks it is either post-traumatic stress disorder or sexual abuse. Dan denies abuse, but he admits he was hit in the head during lacrosse, but notes that he had double vision before he was hit. House sends him to an ophthalmologist. Cameron objects, but House says she's just objecting because she thinks his behavior is all about what she did. Based on her acting like everything is about her, he surmises that she's an only child, which she denies. However, as House looks into the exam room, he notices a twitch in Dan's leg - a myoclonic jerk which only happens in people who are asleep.
They start a differential. Foreman is worried it is neurological, in which case it can't be treated. House rules out Chase's suggestion of infection. House also thinks that the patient's father isn't his biological father. Foreman bets $100 on the opposite. House orders a polysomnigraph while the patient sleeps. The patient dreams that House is cutting off his toes. They confirm the night terrors.
All the tests come back normal. They look at the patient's MRI scans. Chase thinks he has viral meningitis, but House knows he was only guessing. However, House has spotted something - an upwards arch in the corpus collosum, the joint between the two brain hemispheres. House orders a radioisotope examination to look for the blockage. Foreman does the procedure, and looks at the facial structure of the patient and his father to see if he can prove they are blood relations. They find the blockage and schedule surgery.
However, given new evidence, they think it might be multiple sclerosis. They break the possibility to Dan but tell him it will take months to confirm the diagnosis as it is in its early stages. They recommend medication to ease the symptoms and start looking for a specialist.
However, the patient goes missing from his room. The team starts looking for him. They are worried because he had a lumbar puncture and he should not be moved. They call House at home. House shows up at the hospital and tells Foreman to keep looking and that he's going home. He tells Foreman to check the roof because the orderlies sometimes prop the door open. Dan has made his way to the roof where Chase finds him. The patient seems to be dazed and Chase reassures him, but it's clear that the patient doesn't know where he is; he believes he's on the lacrosse field. Foreman keeps talking to him as Chase tackles him to keep him from walking off the roof.
Foreman tells House that the patient thought he was on the lacrosse field. However, House thinks that this shows he doesn't have multiple sclerosis. It also means that he probably has had a brain infection. Cameron thinks it might be syphilis. House wants to use a dose of penicillin, injected directly into the brain using the existing shunt from the lumbar puncture. The father doesn't think the patient has ever had sex.
Cuddy finds out about the paternity bet and bets House's attendance at a symposium against a week of clinic duty. They continue the injections on the patient while Chase tries to distract him by directing his attention to Cameron's low-cut blouse. However, Dan starts having tremors, auditory hallucinations and double vision. They realize the penicillin isn't working. They start to eliminate just about everything it could be from the mnemonic "MIDNIGHT". House focuses back on the night tremors. He orders an EEG along with microphones.
House tells Wilson he's missing something. The parents find him and confront him about doing nothing. The parents say he isn't checking in, but House is totally versed on the patient's condition. He tells the parents to go comfort their son. House plans on using DNA from the father and mother's coffee cups to test paternity. He bets Wilson double or nothing he is right. House checks in on his team and gives them DNA to test.
The tests are negative, except the paternity test - the father and mother are both not related to the son. House goes to confront the parents. They admit the patient was adopted. House admits he tested their DNA. However, the parents say the medical history they him was about the biological mother. House asks if the biological mother was ever vaccinated, but they don't know and say that the patient was. House dismisses them - he needs to know what happened in the first six months of the patient's life when he was relying on his mother's antibodies like all newborns. The parents don't know.
House explains the problem - an infant gets exposed to measles, has symptoms, but in rare cases the measles hides in the brain - acute sclerosing panencephalitis. It only happens in babies whose mothers haven't had measles. Dan will need interferon injected directly into his brain, but it will kill him if they are wrong. They need a brain biopsy, but the only way to do it safely is to go in through the eye. They do it and they confirm the diagnosis.
Foreman starts to explain the treatment, but stops in the technical explanation and simply tells the parents it's dangerous, it could kill him, but they should do it. They agree to proceed.
Cuddy and House argue about the cost to the DNA test. They settle it by having House get to take a week off clinic if he pays for the test. House uses the money he won off the team and Wilson.
They test the patient and he names several animals that start with the letter "O". The patient also says he has known he was adopted for six years - neither of his parents have a cleft chin like he does.
House makes a trip to the lacrosse field, where he imagines watching a game.
[edit] Clinic Patient
A baby has a swollen face, but no fever. The mother hasn't been getting the baby vaccinated because she thinks they are a conspiracy of the pharmaceutical companies. House starts talking about another conspiracy: the market for "teeny, tiny baby coffins" and tells the mother a baby's natural immunity only lasts six months and that her not immunizing her baby will force companies to bring down their prices. When the mother gets worried about what is wrong with her baby, House tells her the baby only has a cold.
The next patient has inserted a nail file into his leg to relieve the pressure of a boil on his leg. It has become infected. House gives him some Vicodin. House wonders why the patient drove 70 miles to Princeton-Plainsboro, passing more than one hospital and doctor's offices along the way, and figures that the patient has sued all the doctors between here and where he lives. House treats him anyway. The patient comes back with a lawsuit. House tells him he has gonorrhea. The patient doesn't believe him. House says he will have to inform the health authorities, who will contact his wife. They bluff each other. House tells him to have it checked out himself - if he can find a doctor.
[edit] Major Events
- House reveals that he only takes cases that he considers to be interesting.
- House starts a bet with Wilson, Cuddy and his team on the grounds that Dan, their current patient isn't related to his parents.
- After learning Dan is adopted, House wins the bets and gets a week off clinic duty from Cuddy as a result.
[edit] Zebra Factor 10/10
Subacute sclerosing panencephalitis is very rare. It only appears in one out of every 100,000 cases of measles, and with measles being such an uncommon disease now thanks to vaccination, there are probably fewer than 100 cases a year in the United States. Even an infectious disease specialist like House would be unlikely to see a case in his lifetime.
[edit] Starring
- Hugh Laurie as Dr. Gregory House
- Lisa Edelstein as Dr. Lisa Cuddy
- Omar Epps as Dr. Eric Foreman
- Robert Sean Leonard as Dr. James Wilson
- Jennifer Morrison as Dr. Allison Cameron
- Jesse Spencer as Dr. Robert Chase
| Previous episode: Pilot | Paternity | Next episode: Occam's Razor |
