The farmer was a patient that House told the medical students about in Three Stories. House didn't use his name to protect his identity. He is portrayed through most of the narrative by Brent Briscoe, but on occasion is portrayed by Carmen Electra.
Dr. House was giving a lecture to a group of medical students about three patients with leg pain. One of them was a farmer.
The Farmer told Dr. House he was fixing a fence when suddenly he felt tightness in his ankle and loss of muscle control.
He came to the emergency room of hospital and was seen by Dr. House. Dr. House asked him if he hiked to the fence and how far it was. The farmer told him that he hiked and it's about a half a mile from his home. House asked him where the pain localized, the farmer told him that it started above his ankle and it's radiating up.
He asked the students what they should do first. Keen Student suggested taking a medical history, but Dr. House pointed out that not very many hereditary or chronic conditions cause leg pain. Nevertheless, he asked the Farmer if he had any history of bone cancer, multiple myeloma, or osteogenesis imperfecta. The farmer did not. Caring Student suggested that it was a blood issue and wanted to run a CBC and a D-Dimer. Rebellious Student suggested it might be a good idea to get an MRI, but Caring Student said a PET Scan would be more useful. However, as they discussed it, Dr. House informed them the patient would have died in the period of time they needed to complete those tests. When the students protested they didn't have enough time to diagnose the patient, Dr. House pointed out that they had plenty of time to examine the patient's leg and had not done so.
In the actual case, Dr. House asked to look at the leg and found a puncture about half way up the shin. It was probably a snake bite. The Farmer didn't mention getting bit by a snake, but he felt a sudden shooting pain and the grass near the fence was long, so it is possible he was bitten without knowing it. Keen Student asked what kind of snake it was, but it was impossible to tell just from the wound. Keen Student was at a loss as to what anti-venom to use if they couldn't identify the snake.
However, Dr. House explained there are people who find those things out for him. In the case, Dr. Foreman and Dr. Chase went to the farm. Dr. Chase wanted to wait for someone from the humane society, but Dr. Foreman pointed out that a snake bite can be fatal within hours. However, a ferocious dog blocked their path, so they had to wait for the humane society in any case. When they arrived, they found a Timber rattlesnake.
Dr. Cameron gave him the appropriate anti-venom, and told him that it will start making him feel better fast. However, the farmer suddenly started having an allergic reaction to it which quickly progressed to anaphylactic shock Dr. Cameron called for epinephrine but the attending nurse said his heart seemed fine. Dr. Cameron realized he would soon be in arrest and all of a sudden, his monitor went flat. She called for the defibrillator and managed to get him stabilized.
However, the Farmer did not respond to the anti-venom and leg was starting to suffer from necrosis. Dr. Foreman noted that the snake wrangler had confirmed it was a Timber rattlesnake, so they had given him the right anti-venom. However, Dr. House noted that the farmer was bitten less than four hours ago, and the snake they found had an almost full venom sac. It obviously wasn't the snake that had bit him. The Keen Student asked if doctors had to know how fast snakes make venom.
No. Unless you get a patient bit by one, then it might come in handy.
Caring Student wanted to go back to find another snake, but Dr. House had his team go online and find out there are only three poisonous snakes common in New Jersey, the other two being the Copperhead and the Coral Snake. If it had been a Copperhead, it would respond to the same anti-venom used for the Timber Rattlesnake. Caring Student wanted to give him the other anti-venom, but Keen Student objected due to the allergic reaction from the other anti-venom. He also suggested it might not be a common snake and that they had to get it right. However, Dr. House pointed out if they had gone looking for another snake the farmer might be dead by the time they came back, but at least they would find out the right snake during the autopsy. Dr. House polled the students about what they should do. They were about evenly split. They realized that half of them would save the patient, and the other half would kill him. Keen Student said they couldn't be blamed for that.
I'm sure this goes against everything you've been taught, but right and wrong do exist. Just because you don't know what the right answer is, maybe there's even no way you could know what the right answer is doesn't make your answer right or even okay. It's much simpler than that. It's just plain wrong.
They offered him the anti-venom for the other snake. If he had a reaction, they were prepared to keep his airways open and his heart beating. He wanted to wait for his wife, but there was no time. They gave him the anti-venom and he did not have an adverse reaction. However he didn't respond to it. They doubled the dose and tried a different anti-venom for the Coral Snake and he was still non-responsive. Then they gave him the first dose, the one he was allergic to, with steroids to prevent anaphylaxis. He still continued to get worse. They tried other anti-venoms and nothing worked. Caring Student realized they had failed and the patient was going to die.
Dr. House told the students that he lied about the Farmer having a wife and child, so it made it easier to break the news. He asked them how they trained to deliver such news and they described how they role played.
Dr. House told the farmer that he would die within the next few hours and the only thing they could do was help him with the pain. The farmer asked what would happen to his dog. Dr. House asked him if he had a neighbor to look after him, but the Farmer said that neighbors don't like him and the humane society wouldn't take him. Dr. House realized it wasn't a snake bite. When the Farmer said he didn't remember being bitten, Dr. House counter that he did - he just didn't want to tell anyone that his dog bit him. If the doctors reported that, they would euthanize his dog because it had bitten someone before. Dr. House told him that he would most likely live, but his dog was going to have to die.
Dr. Chase and Dr. Foreman managed to subdue the very aggressive dog to get a swab of his mouth.
Dr. Foreman told the farmer that his dog's saliva test revealed a type of streptococcus bacteria: necrotizing fasciitis. Dogs have a lot of bacteria in their mouths, but their immune system is different and can fight off diseases that are dangerous to humans. They would have to operate to remove the dead tissue, and they might have to amputate his leg. The surgery went well, although amputation was necessary. He survived, and was fitted with an artificial leg.
The farmer was last seen with his new leg and a new dog on his farm.