|First Appearance||Small Sacrifices|
During his reconstruction, Ramon had spikes driven through the palms of his hands, although the weight of his hands was supported by ropes.
While Ramon was reconstructing the crucifixion, a dark fluid started pouring out of his mouth. His companions got him down and took him to the emergency room of Princeton-Plainsboro Teaching Hospital. In addition to coughing up blood, he was running a fever. The case was assigned to Dr. House.
Dr. House went to see the patient. He explained he vowed to god to reconstruct the crucifixion every year if his daughter didn’t die of terminal cancer. Her cancer went into remission four years ago and he kept the vow. Dr. Chase planned to do a lumbar puncture and Dr. House agreed.
Dr. House was curious about the daughter’s remission and sought out a consult with Dr. Wilson. He had no explanation for it, but said that there are similar cases and, as an oncologist, he’s glad when they happen. Dr. House thought the daughter was misdiagnosed.
The tests for infections were negative. However, Dr. Taub noted that he worked around animals. He suggested rhodococcus equi, a disease common among horses that can spread through open wounds. They brought the news to the patient, but they discovered another symptom - his teeth were falling out. This ruled out rhodococcus.
The team started a new differential. Dr. Taub suggested radiation sickness, but there did not seem to be any radiation source. Ms. Masters suggested Karposi’s sarcoma, but there were no skin lesions. Dr. Chase suggested heavy metal poisoning and Dr. House agreed. He ordered an environmental scan and a peripheral smear.
Dr. House asked Dr. Cuddy to help him obtain the daughter’s medical file, but she refused because of patient confidentiality.
Dr. Chase and Ms. Masters did the environmental scan. They found a very sparsely furnished apartment. Ms. Masters found an old photo of the patient where it was clear he was much heavier. Dr. Chase realized there was hardly any food in the house, and the teeth may have fell out due to malnutrition. This put rhodococccus back on the table.
Dr. House managed to get the daughter’s file and asked Dr. Wilson to look through it.
Ms. Masters confronted the patient about why he didn’t tell them he was starving himself. He said he didn’t think it was relevant, but accepted the dietary supplements they gave him. Ms. Masters noted he looked better, but complained about pain in his legs. Although he rated it as a 9.5 out of 10, he was still smiling. When Ms. Masters pointed this out, he denied he was smiling.
This added another symptom, pseudobulbar affect. When Dr. House told the patient he had an easily treatable condition, the patient’s smile went away. Dr. House admitted he was lying to see his reaction, and the patient started smiling again. Dr. House surmised the patient’s religious devotion could be a symptom and Dr. Foreman agreed that a neurological disorder could explain delusions and his other symptoms. Dr. House ordered an MRI of the patient’s brain.
The MRI showed multiple dense lesions indicating multiple sclerosis. Dr. Chase realized they didn’t consider it as a diagnosis because the malnutrition suppressed the immune system, which is what causes most of the symptoms of multiple sclerosis. Now that he was getting a proper diet, the multiple sclerosis expressed itself. The patient was started on prednisone.
Dr. House explained to the patient that the lesions were affecting his temporal lobe, which often leads to the feeling of strange sensations. However, the patient refused to believe his religious beliefs were the result of his illness. The patient started coughing and when Dr. House offered him water, the patient said he couldn’t move his arm. Dr. House examined him and found he had no sensation in his forearm.
Although paralysis is a symptom of multiple sclerosis, Dr. Chase argued the diagnosis had to be wrong because the patient was getting worse on treatment. Ms. Masters suggested it might be a arteriovenous malformation or a cerebral infarction. However, Dr. House realized Ramon had Marburg multiple sclerosis, a rare, quick acting and usually fatal sub-type with a prognosis of death within three days. There was one experimental treatment with stem cells that might work. However, as stem cells are derived from aborted fetuses, Dr. Chase realized the patient’s Catholic beliefs would never allow him to consent to it. Dr. House ordered confirmation and to seek the consent of the patient anyway.
Dr. Wilson told Dr. House that the daughter’s cancer diagnosis was correct. For some reason, it responded to chemotherapy.
The patient did refuse treatment. Dr. House pointed out the patient’s hypocrisy. He took ibuprofen to deal with the pain of the crucifixion, and had the spikes driven though the palms rather than the wrists, and avoided the lashes and crown of thorns. Dr. House told him not to make it about his daughter. Ms. Masters told him the treatment was his only hope.
After they left the room, Ms. Masters suggested that they let the patient see his daughter and tell her that he’s going to die because the patient won’t accept treatment. Dr. House agreed.
Despite his daughter’s pleas, the patient still refused treatment. He told his daughter that she would understand some day, but the daughter said she never would.
The patient was given treatment and checked with an MRI every 12 hours. The patient started to improve. Dr. House admitted to the patient that he deceived him - his daughter was still cancer free. The patient was angry, but Dr. House pointed out that despite the patient’s decision, nothing bad had happened to him or his daughter. The patient rationalized that God was merciful.
However, Ms. Masters was upset as she was the only member on the team who was not aware of Dr. House’s deception. She realized that if Dr. House had told her, the patient would be dead.