After defeating a much larger opponent, William became disoriented. When he removed his helmet, Queen Shannon noticed that the whites of Williams eyes were red. He soon collapsed. King Miles called 911 for an ambulance.
Dr. House found out about the case from the emergency room after the patient was determined to have suffered a seizure. Dr. Foreman suggested it was just a concussion, but Dr. Chase dismissed that as the ER would have ruled it out before calling Dr. House. Dr. Taub noted that although Williams armor would have protected him from obvious trauma, it would not protect him from transmitted force - he might have a subdural hematoma. However, it would not explain the red eyes, which were the result of bleeding in the sclearae. Dr. Hadley thought it might be an allergy and Dr. House agreed the renaissance fair had to be checked out. He ordered Dr. Foreman and Dr. Hadley to do an environmental scan and Dr. Taub and Dr. Chase to do an MRI in case it was a hematoma.
The MRI showed no sign of a hematoma or any other abnormalities. However, William vomitted during the procedure. They thought it might be food poisoning and called the others. Dr. Hadley spit out the drumstick she was eating. Miles and Shannon came by to help them out. Dr. Foreman found some more vomit inside the tent, as well as what King Miles identified as a cow eye. Shannon told the doctors that Miles often makes the knights eat disgusting food just before the fights. Dr. Foreman wondered why William hadn’t mentioned it, and Miles said the knights swore an oath of secrecy and William took those things seriously. The doctors took a sample.
Dr. Hadley pointed out serious bacterial food poisoning would explain both a seizure and vomiting. Dr. Chase wanted to do a lumbar puncture. However, Dr. House dismissed the suggestion as none of the other fair participants were sick. He still thought it was an allergy and ordered scratch tests on the samples. Dr. Chase said William was getting worse, so Dr. House ordered epinephrine as well.
Dr. Foreman administered the epinephrine. Dr. Hadley started the scratch test. However, William started complaining he felt weird, like his chest was going to explode. Dr. Hadley realized he had developed an arrythmia. Dr. Hadley grabbed the defibrillator, but when they opened up his gown, they saw spots on his chest. Dr. Hadley managed to shock him back to sinus rhythm.
Dr. Foreman realized that William’s adverse reaction to the epinephrine ruled out allergies. Dr. House thought William might be allergic to sodium bisulfite, the preservative in epinephrine, which can cause tachycardia. However, Dr. Taub pointed out that Wolf-Parkinson-White syndrome causes both tachycardia and explained the red eyes. It also caused abnormal electrical pathways in the heart which would explain the seizures. However, Dr. Foreman pointed out it wouldn’t explain a skin infection. Dr. Hadley realized that staphylococcus would cause both skin infection and neurological damage. Dr. House ordered him tested for it, as well as ordering that William be moved into isolation and be given intravenous antibiotics. They were also concerned that Dr. Foreman had been exposed to it when he touched the patient without gloves.
Shannon reported that William’s pain had gone down, but when she left the room, he told Dr. Hadley the pain in his chest was actually getting worse. Dr. Hadley realized William was in love with Shannon and asked why he hasn’t told her. He said that Miles is his friend too and he couldn’t do that to him. He then started complaining of sharp pains in his back.
Luckily, MRSA was ruled out. The infection appeared to be in the clostridia family, but that didn’t narrow it down much as there were hundreds of different bacteria like it. Clostridium perfingens wouldn’t cause his other symptoms. Tetanus appeared to be unlikely as most people have been vaccinated. Taub thought he might have had a cut and not gotten a booster shot. However, Dr. House came in and said it was just poison ivy. If he had inhaled the burning leaves, it would explain the symptoms that wouldn’t be explained by just contacting it. When Dr. Chase showed skepticism, Dr. House showed him rashes on his own hands where he had handled William’s sword.
At that point, the team was paged to William’s room. Dr. Hadley had noticed William had developed bradycardia. She asked why Dr. Taub and Dr. Chase had not gotten into their isolation suits, and they told her it wasn’t MRSA. Dr. Chase administered more epinephrine to prevent cardiac arrest despite Dr. Taub’s protests. At first, Williams heart stopped, then it returned to a normal rate.
It was obvious the bradycardia wasn’t caused by poison ivy or epinephrine. That meant that the heart symptoms were part of the overall problem. Dr. Chase returned to the clostridium. Dr. Hadley pointed out most clostridium infections are harmless, but Dr. Chase pointed out if he were immunosuppressed they would spread. Leukemia is the most likely candidate for immunosuppression, but Dr. Foreman pointed out that if he had it, he would have shown symptoms well before the fight. Dr. House realized any immunosuppressing disease would have shown earlier symptoms, but a toxin would not. Dr. Chase suggested trichinosis from infected meat, but to Dr. Hadley’s surprise, all the food preparation facilities at the fair checked out clean. Dr. House thought trichonosis was most likely and ordered a muscle biopsy to confirm.
Dr. Hadley prepared William for the biopsy. She told William that Shannon was probably waiting for him to tell her how he felt about her. However, the muscle biopsy was clean, ruling out trichonosis. Dr. Hadley was sure the cause wasn’t environmental. However, Dr. Foreman was willing to entertain the possibility they had missed something at the fair. Dr. Foreman suggested a fungus - it fit his symptoms even though the blood tests didn’t indicate any sign of a fungal infection. Dr. Foreman proposed double checking everything for a fungus anyway. Given Dr. House’s current pain level, he was unlikely to accept anything should be ruled out until it was tested.
Williams was soon complaining that his legs felt like they were on fire. An examination showed severe bruising on both legs. It was a sign of rhabdomyolysis and kidney failure. Dr. Foreman was sure that environmental causes had to be ruled out. Dr. Taub suggested a full cancer workup. Instead, Dr. House ordered an environmental scan of William’s apartment even though he hadn’t been there for three weeks. Dr. Foreman asked Dr. Chase and Dr. Hadley to do the environmental scan while he and Dr. Taub looked for cancer by doing an ultrasound of the liver.
The ultrasound appeared to show several tumors. However, when Dr. Foreman asked for a closer look, the “tumor” appeared to move. He didn’t know what it was, but it wasn’t cancer.
Dr. Chase and Dr. Hadley examined the apartment and found a locked door. Dr. Hadley found the key and they found a room full of witchcraft paraphernalia. They found several vials that they took for testing. William assured them it was just sugar water. Dr. Taub thought he might have poisoned himself, but Dr. Foreman said any poisons would have shown up in the blood tests. However, Dr. Taub suggested the poison might have collected in the liver and that the “tumors” they found were focal hepatic lesions filled with blood. When they burst, they would deliver a dose of the poison. However, Dr. House noted that some of the figurines were made out of lead, suggesting heavy metal poisoning. This would explain his symptoms. Dr. House ordered a biopsy of the liver cysts.
However, the blood tests and biopsy were negative for lead, even though Williams heart rate and blood pressure were getting more erratic. He needed to be defibrillated twice. Dr. House decided to visit the fair himself. Dr. Hadley protested that they hadn’t missed anything. Dr. House saw the apothecary and Dr. Hadley insisted they had already checked it out. However, the apothecary assistant knew less about the herbs in the shop than Dr. House did himself. Dr. House identified rose hips, black cohosh, and then saw hemlock. The assistant said he sold some to Miles.
Dr. House went to confront Miles about poisoning William. Miles admitted he fed some to William as part of the food challenge, but he thought it was just wild carrot. He couldn’t explain why none of the other knights that ate it weren’t sick.
However, the blood tests confirmed hyparadine alkyloids from hemlock, although in trace amounts, as well as markers for hemlock intoxication. However, William wouldn’t accept Miles would try to poison him. However, Dr. Taub soon noted that despite the gastric lavage and activated charcoal they gave William for hemlock poisoning, he was still getting worse. Dr. House noted he had taken it two days ago and was lucky to still be alive. However, Dr. Taub noted that even if he was exposed two days ago, he would either be dead already or improving with treatment. He realized he did have hemlock in his blood, but it wasn’t what was killing him.
Dr. House finally realized that the ultrasound of the liver actually showed peliosis hepatis lesions . Combined with arrythmia, this suggested endocarditis and an infection of a heart valve. These are common with anabolic steroid abuse, as is rhabdomyelitis. The hemlock merely accelerated the damage. When confronted, William admitted to steroid use, but he improved quickly with treatment. He said although he would not compromise his ideals for love, but he would just to win a game. He told Dr. Hadley that Miles was a great, smart and wealthy guy and Shannon would have a great life with him.