Nozick is the agoraphobic patient in the episode The Itch.
Case History Edit
The patient collapsed in his home. His neighbors contacted emergency services who broke in his front door to recover the patient. However, when he was taken outside, he suffered extreme anxiety due to his agoraphobia, attacked the emergency team and ran back into his house demanding to be left alone.
Dr. Cameron, who knew the patient from a hospital outreach program, took a medical history and determined that the patient was suffering from crushing headaches and had experienced three seizures in the past two days. He developed agoraphobia after being shot during a mugging that cost his girlfriend her life. She advised Dr. House that the patient would not consent to being brought to the hospital. The portable equipment used on the patient could not detect tumors or vascular problems. Dr. House suggested provoking a seizure while they perform an EEG. This would indicate where the problem was.
Dr. Cameron and the team proceeded to the patient's house, but the patient was resistant to letting them in. He agreed to let them in as long as only Dr. Cameron entered his bedroom. Dr. Kutner believed that the patient might be suffering from post-traumatic stress disorder.
Dr. Cameron hooked up the patient to an EEG and attempted to provoke a seizure. Her presence was making the patient anxious. The environmental scan was negative. They also failed to induce a seizure. The patient's first seizure was in his entry hallway, so Dr. House suggested making the patient anxious. Dr. House went to the patient's house with strangers and entered his room. The patient started to become anxious, but did not have a seizure. Instead, he had intense abdominal pain.
Dr. Cameron used the sonogram to find an intestinal blockage. The patient required an MRI or exploratory surgery, but refused to be taken to the hospital despite the risk of peritonitis. Dr. House offered to bring a surgeon to the house and the patient agreed. However, House planned to put the patient under anesthetic at the house, then take him to the hospital.
A mock surgical suite was set up in the patient's home, and he was successfully put under anesthesia and taken to the hospital. However, once Dr. Cuddy learned about the plan she insisted the patient be kept in the hospital after the operation instead of being taken directly home to prevent post-op infection. However, the surgery did not take place as Dr. Cameron revived the patient before the operation. The patient became combative and could not be sedated.
The patient returned home and appointed a lawyer as his medical proxy. Dr. Cuddy removed everyone from the case.
Dr. House suggested Dr. Cameron attempt to convince the patient to let them back on the case and to treat the intestinal blockage with lactulose. Dr. Cameron managed to re-gain the patient's trust. The patient's symptoms continued to get worse. Dr. Cameron convinced Dr. House to do the surgery in the patient's house. Dr. Taub performed the exploratory surgery assisted by Dr. Kutner. The surgery indicated intestinal atrophy, most likely from Whipple's disease, which would explain the seizures and abdominal pain. The patient suffered a minor burn when a cauterizing iron ignited intestinal gas. The burn was dressed and the patient was put on antibiotics.
After treatment, the patient's legs became numb, the result of peripheral neuropathy. Dr. Kutner suggested porphyria, but the patient's liver was fine. Dr. Foreman noted that the intestinal problems would also be consistent with Celiac disease. Dr. Cameron wanted to run blood tests, but Dr. House opposed them as slow and inconclusive. He suggested feeding the patient wheat to see if provoked an allergic reaction in the duodenum. However, Dr. Cameron objected - she felt that Dr. House was merely trying to provoke pain to force the patient to agree to come to the hospital. Dr. Foreman decided to do both the force feeding and the blood tests.
Dr. Cameron attempted to discuss the patient's agoraphobia, and he denied he had post-traumatic stress disorder. He claimed to always be anxious when outdoors until he met his girlfriend.
The force feeding was inconclusive. When the patient was being prepared for an endoscopy, he suffered a cardiac arrest. Dr. House obtained permission to take him to the hospital from the proxy, but Dr. Cameron used the portable defibrillator and stabilized him.
The patient became braidicardic and required a temporary pacemaker. Dr. Kutner thought it might by lymphoma, but Dr. House dismissed it because it would have shown up on the portable scanners. Dr. House believed it had to be a toxin. Dr. Kutner suggested organophosphates as he saw rose petals in the entryway. When Dr. Hadley noted the patient's house was very clean, Dr. House asked the patient if he used both bleach and ammonia. When the patient confirmed that he did, Dr. House diagnosed chlorine gas poisoning, which was consistent with his symptoms. He ordered steroids and sodium bicarbonate. However, if this was correct, the patient would need a permanent pacemaker - a procedure that could only be done with a flouroscope in a hospital. Dr. Chase refused to perform the procedure at the patient's house.
However, despite the treatment, the patient's vital signs kept dropping and his abdominal pain got worse. Dr. Cameron was aware of the deception about the morphine and put him back on it. However, when Dr. House realized he was on morphine when he got the abdominal pain, he reviewed the patient's x-ray. He believed it showed bullet fragments in his legs. Dr. House performed minor surgery to remove the fragments because they were causing lead poisoning. Dr. Cameron started chelation. Dr. House also confirmed that the patient was suffering from post-traumatic stress disorder as it appeared obvious that the roses were for his girlfriend's birthday. He did want to leave the house to visit her grave site.
The patient recovered and managed to step outside his front door.