President Dibala was the ruthless African dictator that was the patient in the episode The Tyrant. He was killed by the treatment that Foreman gave him because Chase masked what Dibala's real illness was.
Case History Edit
Dibala was admitted after vomiting blood. The case was assigned to Dr. Foreman who asked for the help of Dr. Chase and Dr. Cameron. Dr. Cameron objected to treating Dibala, but Dr. Cuddy noted that President Dibala was a guest of the U.S. government and asked her to stay on.
Dr. Foreman suspected hemorrhagic ulcers in the lungs, but when he arrived in his office, he found Dr. House waiting for him. Dr. House's medical license had not yet been restored, so he assured Dr. Foreman he was still in charge. Dr. Chase noted that Dibala thought someone had tried to assassinate him with polonium, a radioactive element. However, the FBI had already done an environmental scan for radioactivity and had found none. Dr. Cameron thought it might just be acid reflux, but Dibala had no history of asthma or heartburn. Dr. Foreman noted he had an insect bite on his hand which might mean malaria. He wanted to start him on Coartem(TM). However, Dr. House thought that a toxin fit better with vomiting and the insect bite might just be chloracne from dioxin poisoning. Dr. Foreman agreed and ordered Olestra.
Dr. Foreman went to Dr. Cuddy to straighten out the working arrangements with Dr. House. She instructed Dr. House not to do procedures or have any contact with the patient.
Dr. House came to the conclusion that Dibala had Lassa fever and suggested ribavirin. However Lassa fever is not endemic to Dibala's country and the "insect bite" faded, ruling out dioxin. Dibala was also running a slight fever. Dr. Chase suggested Ebola or Marburg, but the incubation period for those diseases is much shorter. Dr. House suggested Dibala might have travelled to a country, like Nigeria, where Lassa is endemic. However, neither Zimbabwe or Egypt had Lassa either. Dr. Chase suggested schistosomiasis, but there were no sleep disturbances. Dr. House pointed out that in Egypt, Dibala had been in contact with a delegation from Liberia that had just been hit with Lassa. Dr. Foreman finally agreed to start the ribavirin.
Dibala insisted that Dr. Cameron take blood from a former resident of Dibala's country in order to make serum that was more effective than ribavirin. Dr. Cameron initially refused, but after speaking to the donor and Dr. Cuddy, she agreed to do the procedure.
Soon after, an assassination attempt was made on Dibala's life. While checking the patient, Dr. Chase noted that his right eye was bloodshot. It was traced to an elarged lymph node blocking the retinal vein. Dr. Foreman thought it might be sarcoidosis. However, the x-ray didn't show any hilar adenopathy, which ruled it out. Dr. Foreman next suggested Staphylococcus, but the fever wasn't high enough. Dr. Chase thought it might be another infection, but Dr. Foreman thought the fever might be misleading. He thought it might be lymphoma. However, Dibala's LDH was normal. Dr. Foreman though that Dibala's excellent liver function was masking the elevated levels. He ordered a lymph node biopsy.
Dr. Chase performed the biopsy; the sample looked normal and the cells were neatly differentiated, ruling out lymphoma. Dibala was informed about the results. However, it was clear that he had lost his short term memory. In addition, his fever got worse.
Dr. House next suggested scleroderma based on the fact his skin seemed too tight for a man of his age. However, Dr. Foreman was still thinking infection and the nodules on Dibala's fingers pointed to blastomycosis. Dr. Chase agreed, if it was a fungus, they would have seen lesions on the head CT Scan. Dr. House noted that fungal lesions are often missed on a CT Scan. Dr. Cameron suggested an anticentromere antibody test but Dr. Foreman pointed out that would only indicate scleroderma, not prove it. In addition, given the severity of the fever, they had to decide right away. Dr. House pointed out the wrong treatment would speed the progression of the disease. Dr. Foreman finally ordered amphotericin for blastomycosis. Dr. Cameron administered the medication.
Dr. Cameron still wanted to do the antibody test. Dr. Chase agreed to get the sample. The test was positive and they went to Dr. Foreman to ask that he switch him from anti-fungals to steroids. However, Dr. Foreman still thought that blastomycosis was a better fit. Dr. Cameron commented that when he makes bad decisions, he often gets insecure and retrenches. She asked him not to do the same thing here. Dr. Foreman finally relented and ordered steroids.
Dibala was soon in distress. His oxygen SATs dropped to 88%. He had numerous bleeds in his lungs and Dr. Chase inserted a bronchial tube and started cauterizing the bleeds. However, he started bleeding into his lungs and there were over a dozen bleeding sites. He started to go into cardiac arrest. Dr. Foreman called for the defibrillation paddles, but Dibala had flatlined and they were unable to restore a heart rhythm. He was pronounced dead.
Because of the sensitivity of the situation, Dr. Foreman was not allowed to perform an autopsy.
Dr. Chase later admitted to faking the antibody test with blood from a scleroderma patient in the morgue. Dr. Foreman agreed not to reveal this and destroyed the morgue sign-in log.