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Three Stories
House before surgery S01E21
Director(s)
Writer(s)
Airdate
May 17, 2005
Episode Number
1.21
TV.com Rating
9.3/10
Final Diagnosis
Zebra Factor
Patient 1: 8/10; Patient 2: 2/10; Patient 3: 10/10; Professor: 1/10


For the seventh season episode where House gives a talk to a group of elementary students, see Two Stories.

"I’m sure that 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."
―Three Stories

Three Stories is a 1st season episode of House which first aired on May 17, 2005. Cuddy wants House to deliver a lecture to the medical students on diagnostics, and House finally agrees when she lets him off of clinic duty for a couple of hours. On the way to the lecture, he finds his ex-girlfriend coming to see him to ask him to treat her husband. After refusing, he heads to the lecture where one of the cases he presents starts to look very familiar.

In addition to being one of the best episodes of House, it is a critical episode in the development of House's character and his backstory. Up until this episode, House finds it easy to wisecrack with Cuddy, Wilson, patients, family and fellows alike. Even on his best behavior on a date with Cameron, he breaks the news that he thinks she only likes him because of how damaged he is. Although there are clues to the contrary throughout Season 1, it would be easy to convince oneself that House is indeed past the point where he wants or needs any human connection whatsoever. Even Cameron has determined he is incapable of love, empathy or affection.

However, all this goes out the window when Stacy Warner shows up. Although mentioned earlier in the series, House has insisted he is over her. We are left to wonder what kind of woman could possibly be "House's former girlfriend". When a beautiful, intelligent, kind woman shows up and greets him with "Greg" instead of "House", we expect House to treat her just like he treated the overly familiar Marty Hamilton earlier in the season. Instead, the wisecracks instantly disappear. House actually looks vulnerable and we realize later that the reason he isn't putting up his usual defensive is that Stacy would see right through it. She knows how much she means to him and hopes that in her time of need he will help her. House has no intention of doing so, but even when he blows her off by implying he would prefer her husband die rather than treat him, it's clear his heart isn't in it.

The lecture tells us even more about House. Surprisingly, he's astounding at it despite his reluctance and his slow start. At every turn, he sucks the students in by allowing them to confirm their own biases by deflecting their assumptions with truthful but misleading answers like "that's what usually happens". However, he quickly turns on the students when they start jumping to conclusions and fail to delve deep into their knowledge. When Cameron lets the cat out of the bag, we see the lights go off in their heads - how could they have been so stupid as to have missed something so obvious. Like the contemporaries of Sherlock Holmes, they have seen, but they have not observed. The lecture has its desired effect, teaching the students both about the necessity of thinking through an initial diagnosis and introducing important issues about medical ethics.

This episode is the first use in the series of telling the story in Anachronic Order, but it would not be the last. The similarly named Two Stories and Nobody's Fault later in the series also make use of the device of telling the story out of chronological order.

In many episodes of the series, the patient appears to represent a part of House. In this episode, the tables are turned - there are three patients who, as it turns out, could have been House's case. The symptom they come to the emergency room with is identical in each case. Even his fellows are fooled for a while. For the audience, it's a guessing game like "To Tell The Truth" - one of the patients is the real House and he's gone to great lengths to keep enough detail out of the stories to keep everyone guessing. When House starts to take one of the cases personally, Cameron has her "House moment" and realize House is expressing anger about his own case.

In addition, like many episodes, the patient has a "moral failing" and it appears they are being punished for it. In the case of "Mid 30's man", his leg pain is dismissed as the direct result of his drug abuse. However, the real situation is more complicated than that. Only the Volleyball Player is actually truly innocent - her condition is not due to anything she did and she is truly morally blameworthy. Ironically, it's the Farmer who is being punished for his moral failure, and it costs him his leg when he protects a dog that's just plain mean. Even more ironically, although it seems House was the one being punished for his drug use, like many other patients on the series, his illness is totally unrelated to his moral failing - he could have abstained his whole life and that aneurysm would have given way at some point. As such, with House, the equation is more complex - would the doctors have taken his leg pain more seriously if he hadn't been a drug seeker?

The episode also raises other parts of House's backstory, such as his earlier connections to Cuddy, his near-death experience and, most importantly, the full story behind his disability. However, one issue that remains unclear was whether House became a drug addict before or after the infarction that gave rise to his disability.

The episode is also the most honored episode of the series to date, winning the Emmy for Outstanding Writing in a Drama Series for its writer, David Shore, in 2005 and a Humanitas Prize in 2006 - the top honor a television show can obtain, given to award outstanding writing promoting humanity, dignity and freedom. It is the series' top rated episode on TV.com, receiving a 9.3 out of 10. It finished 7th in Facebook's poll of the best episodes of the series completed in April, 2012.

Recap Edit

Cuddy calls House to her office and assigns him to serve as a substitute for an ailing professor. He protests, but then reluctantly agrees to give a lecture on the topic of diagnostics in exchange for Cuddy absolving him of two hours of clinic duty.

On his way to the lecture, Stacy Warner appears, and she makes a request for House to take on the case of her husband Mark. House glances at Mark's file and determines it isn't worth his time, as nothing seems to be seriously wrong with him. When Stacy persists, House admits that he's not sure he wants Mark to live if he is sick. He tells her it’s good to see her again and leaves.

At the lecture hall, House is speaking to an audience of perhaps a few dozen medical students, only two of whom initially appear to be engaged in his talk. He grills the students on what they would do in various clinical situations and drifts the lecture to the introduction of three (presumably real) case scenarios in which each patient has presented with leg pain. House notes that, statistically, leg pain is most frequently muscular-skeletal, the result of trauma from an accident, or varicose veins from pregnancy. He begins a detailing of the three case studies in which the only symptom is leg pain.

(Note: This recap does not conform to the story structure of the episode, but instead for clarity focusses on each of the three cases as if they were each separate plots.)

First PatientEdit

The first case is that of a middle-aged farmer, whose leg started hurting while he was fixing his fence. The pain originates in his ankle and radiates upward. House interrogates the students as to their next steps and after they make a few suggestions, he tells them the patient has died during all the tests. He stresses to them the priority of getting an actual visualization of a sore leg upon presentation, as opposed to just jumping straight to testing and possibly wasting time and patient comfort.

The farmer's examination shows a puncture wound, leading the students to conclude that it is a snake bite. Foreman and Chase are shown searching the farmer's property for poisonous snakes, and they find one in his field - a timber rattlesnake. The farmer is given anti-venom for this particular species of snake, but he has an allergic reaction to it and goes into anaphylactic shock. While this is successfully reversed with adrenaline, he continues to get worse. However, House notices the snake the wrangler caught had too much venom in its sac to have bitten the farmer. One student proposes looking for other snakes, but House states that there are only two other venomous snakes in New Jersey and that if the snake that bit the farmer is not a native, the man will die while waiting for it to be properly identified. The students absorb House's point that either viable choice—to attempt further treatment with or without proper species identification—could kill the patient. House himself had decided to give the farmer the other anti-venom, but his condition still worsened.

The farmer's puncture wound expands into a massive sore. Now the patient has to be told that he is dying. House tells the students how good Wilson is at breaking this kind of news - glibly remarking that patients actually thank him. However, when House simply and bluntly informs the farmer, his first and only thought is about his dog. House asks the students if they were ever taught that a patient's response can be an effective diagnostic tool. House realizes the genuine source of the farmer's flesh-eaten injury as a dog bite, alleging that the dog has bitten others and that the farmer just wanted to protect his pet from being euthanized. The dog's saliva was full of opportunistic bacteria, harmless to the dog because of its immune system but extremely damaging to its owner, giving him Necrotizing fasciitis. The farmer's leg now may require amputation.

During a break from the lecture, House discusses Stacy with Wilson. Wilson reminds House that Stacy loves him but can't stand being around him, and House's students remind him that break time is over.

Zebra Factor: 8/10
Fasciitis is very rare, and is often misdiagnosed as a result. It often has to be well advanced (to the point where amputation is needed) before a diagnosis is obvious, and is often mistaken for more common infections that are less aggressive, such as staphylococcus.

Second PatientEdit

The second case is that of a volleyball player who suffered an acute attack of leg pain during game practice. Although the coach thought the pain was from a pulled muscle, it is really caused by tendonitis. House warns the doctors not to care about the patient too much. Dr. Cameron insists on performing an excessively detailed history in addition to a full workup, the latter of which finds a nodule. Although the nodule itself would likely be unimportant, its presence together with signs of clinical depression requires the team to thoroughly test the patient with an expensive, invasive and painful procedure. The patient responds to the anti-inflammatory drugs she's given. A thyroid test reveals she also has a thyroid condition—but she didn't respond to treatment for it, and in fact gets worse. The patient also becomes ultrasensitive to touch, which indicates an adenoma, but doesn‘t tell them where. After first scanning the area of the thyroid gland, Cameron scans the leg around the nodule in the leg and finds a cancerous adenoma. The adenoma must be removed even if it means amputation. Although her diseases are unrelated, the thoroughness of the examination allows the source of her leg pain to be swiftly detected and treated.

Zebra Factor: 2/10
Cancerous adenomas are not terribly rare, although most are benign.

Several dozen more seats in the lecture hall are now filled, and House's team starts to show up as well.

Third PatientEdit

The third case is disguised by saying the patient was Carmen Electra, who complained of pain after playing golf. However, the patient soon morphs into another middle aged man. The patient has decreased reflexes and is complaining about a lot of pain. House gets a painkiller, but while asking the students whether it is safe to inject a patient without a medical history, the patient grabs the syringe and injects himself - drug seeking behavior.

Later, the patient returns to the hospital complaining about more pain. House points out that even drug addicts get sick. In order to confirm that the patient is really in pain, the doctor orders a catheterization without anesthetic, saying that if the patient can handle the catheter for half an hour he is really sick and isn't seeking drugs. It soon turns out the patient has blood in his urine, which has turned tea-colored. House explains that this is the result of both blood and waste products accumulating in the urine. He then asks the class for a possible diagnosis. House becomes angrier with each wrong answer, until Dr. Cameron guesses "muscle death". Dying muscle releases myoglobins which poison the kidneys. The attending doctors didn't realize this for three days, at which point the patient suggested it. Cuddy tells him they may have to remove the leg. The thigh had a clotted aneurysm which led to an infarction.

It becomes apparent [to Dr House's team] that 'Carmen Electra's case is actually Dr. House's own experience. He refuses the amputation. Cuddy tries to talk him into it, but House opts for a bypass, despite the risks that the dying muscle will a) put him in pain, b) poison his organs from the return of the dead muscle tissue to his bloodstream, and c) have him risk cardiac arrest because of the extra potassium that will also enter his bloodstream when circulation is restored. Stacy, his girlfriend at the time, thinks he is an idiot for not going with the much safer course of amputation.

They schedule surgery to break up the clot, and although that goes well, House is now in terrible pain, and wants more morphine even though he‘s at the maximum dose. Cuddy tells Stacy that House could either recover almost fully, or could have thigh pain the rest of his life. Cuddy suggests a middle course - cutting out the dead muscle. Meanwhile, House tries to save himself from a cardiac arrest by telling the nurse to give him a dose of calcium glucinate, but he doesn't get dosed in time to avoid it, and clinically dies for almost a minute.

Stacy pleads with House to agree to amputation. House sticks to his guns, even when Stacy reminds him about how he browbeats patients who make the wrong choice all the time. He realizes the pain alone might kill him, so he asks Stacy to have him put in an induced coma. He appoints Stacy as his medical proxy while he is unconscious. It is obvious that Stacy is going to go against House's wishes when he is out. While he is unconscious, Stacy, believing herself to be doing the right thing for him, agrees to the operation to remove his dead thigh muscle.

Because of the thigh muscle removal, the patient will always limp.

Because of the delay in diagnosis, he will suffer chronic thigh pain for the rest of his life.

Zebra Factor: 10/10
Any form of muscle death is incredibly rare, and although infarctions are common, infarctions in the arteries of the leg are also rare.

Fourth Patient Edit

At the end of the lecture, the hall is standing-room-only when Dr. Cuddy arrives. She's the only one who notices that the lecture has gone 20 minutes over. House ends the lecture by insulting the paternal abilities of the absent doctor, then declares the diagnosis - Dr. Riley's son gave him a drinking mug made with lead-based paint.

Zebra Factor: 1/10
Lead poisoning is the most common type of heavy metal poisoning.

After the lecture, House calls Stacy and agrees to see her husband the following morning.

CharactersEdit

CastEdit

Guest StarsEdit

Major Events Edit

  • The story behind House's infarction is finally revealed.
  • Stacy Warner, House's ex-girlfriend returns to the hospital, asking for House's help in treating her husband, Mark.

Trivia & Cultural ReferencesEdit

  • Girls Gone Wild is a popular video series which features amateur women baring their breasts for the camera during public celebrations, such as Mardi Gras.
  • Baywatch was a television program about lifeguards and featured several attractive women in starring roles, including Carmen Electra.
  • Unlike Carmen Electra, Meryl Streep is a legitimate actress with 17 Oscar nominations and two wins.
  • The nickname for the farmer's dog, Cujo, is a reference to a Stephen King novel about a family terrorized by a St. Bernard with rabies.
  • More about the Timber Rattlesnake, the Copperhead and the Coral Snake.  When this episode aired, Coral Snake antivenom was still available in the United States.  However, the antivenom was discontinued and existing U.S. stocks expired in 2009.  The current treatment for Coral Snake bite is supportive ventilation until the venom runs its course.
  • Series creator David Shore was the episode's writer, and the format of the episode is a great departure from his earlier writing work. Shore termed the narrative style "false flashbacks". He was uncertain about how the episode would be received, feeling it would either be well above average or well below average.
  • The narrative style of false flashbacks is drawn from a French science fiction film, Je t'aime, je t'aime, and a Hitchcock thriller Stage Fright. However, many fans have pointed to the similarities between this episode and Bryan Singer's The Usual Suspects.
  • In all the flashback scenes, Cuddy is wearing slacks. At all other points in the series, Cuddy always dresses in skirts or dresses.
  • The photograph on the House, M.D. - Season One DVD cover was inspired by the scene where House and Wilson sit and discuss Stacy's return to the hospital.
  • The entire Housy story arc draws heavily on the plot of the classic movie Casablanca. In the film, Rick (Humphrey Bogart) initially rejects Ilsa (Ingrid Bergman) when she comes to him for help, but Rick later has a change of heart and reaches out to her.

GoofsEdit

  • Like most people, House spells it tendonitis which, although acceptable, is not entirely correct - the formal term is tendinitis.
  • Although the Timber Rattlesnake and Copperhead are found in New Jersey, the Coral Snake isn't. It prefers warmer weather and is found no further north than South Carolina.
  • When the patients are being operated upon, their eyes should be taped shut to keep their eyes lubricated as patients under anesthesia don't blink.
  • House's doctors should probably have been more concerned about the high creatine kinase levels. However, even with that symptom, muscle death is still a big zebra and would probably be the last thing a physician would consider.

ReviewsEdit

The only argument is whether this episode was the best episode of Season 1 or the best episode of the series. Some fans and critics also feel it is one of the best episodes of any series ever. Reviews were uniformly positive, and many critics noted not only that the show broke away from the series' usual narrative form, but also broke with the narrative form for medical dramas and procedural dramas as well. One reviewer noted that if the episode had been a feature film, it would most likely have been studied in film programs for its innovative use of story structure. In addition to winning an Emmy Award for Outstanding Writing in a Dramatic series and the Humanitas Prize (for "its poignant probe into the pain and confusion that comes when someone we love disappoints us"), it was also nominated for a DGA Award for Outstanding Directorial Achievement in a Dramatic Series. It is widely regarded as being the reason the show won the Peabody Award that year as well. On its first showing, it drew an audience of 17.68 million viewers, the 14th most viewed program that week.

  • On TV.com, it received a rating of 9.3, the highest for any episode in the series.
  • Users of IMDB have rated it even higher - a 9.5, with over 77% of users giving it a perfect 10.
  • Polite Dissent gave the classroom scenes an A+, but didn't like the soap opera portion as much, and gave decent but mixed reviews on the rest of the medicine.

In other languagesEdit

Title
German Drei Beine (Eng. Three legs)
Latin America Tres historias(Direct translation of "Three Stories")
Spain Tres historias
France & Quebec

Cours Magistral (Eng. Lecture, lit. Masterly Class)

Czech Republic Tři příběhy (Direct translation of "Three Stories")

International release datesEdit

  • USA and Canada - May 17, 2005
  • Estonia - May 19, 2006
  • Hungary - August 9, 2006
  • Germany - September 26, 2006
  • Finland - February 8, 2007
  • France - April 11, 2007

QuotesEdit

Caring Student: It's the patient's call.
Rebellious Student: The patient's an idiot.
House: They usually are.

Stacy: God, you're an idiot.
House: I think I'm more of a jerk.

Stacy Warner: Did you think I wasn't going to get married?
Dr. Gregory House: Not to someone so poorly endowed. This guy's pancreas is pathetic.

Dr. Gregory House: Personally, I choose to believe that the white-light people sometimes see, visions this patient saw. They're all just chemical reactions that take place when the brain shuts down.
Dr. Eric Foreman: You choose to believe that?
Dr. Gregory House: There's no conclusive science. My choice has no practical relevance to my life, I choose the outcome I find more comforting.
Dr. Cameron: You find it more comforting to believe that this is it?
Dr. Gregory House: I find it more comforting to believe that all *this* isn't simply a test.

Dr. Gregory House: Three guys walk into a clinic. Their legs hurt. What's wrong with them? [The Keen Student shoots his hand up] I'm not going to like you, am I?

Dr. Gregory House: You know what's worse than useless? Useless and oblivious.

Dr. Gregory House: It is in the nature of medicine, that you *are* gonna screw up; you *are* gonna kill someone. If you can't handle that reality, pick another profession. Or, finish medical school and teach.

Stacy Warner: Morphine will kill you.
Dr. Gregory House: I can handle it.
Stacy Warner: You're in pain, you're not thinking right!
Dr. Gregory House: That's why I need the damn morphine!


Dr. Gregory House: And this guy is *not* the "World's Greatest Dad". Not even ranked. Who the hell lets their kids play with lead-based paint? That's why he's always sick. Find him some plastic cups and the class is all his again.

Dr. Gregory House: His MRI showed that the leg pain wasn't caused by the self-injection. It wasn't caused by an infection. It was an aneurism that clotted. Leading to an infarction.
Dr. Eric Foreman: [to Cameron] My God, you were right. It's House.

Dr. Gregory House: Okay, that's enough about the volleyball player. What's up with the farmer?'
Dr. Eric Foreman: What farmer?
Dr. Gregory House: Snakebite guy. Oh, right, you guys don't know about him. He doesn't get bitten until three months after we treat the volleyball player. Luckily, it's been well established that time is not a fixed construct.

House: Our guy got bit less than four hours ago. There's no way a snake regenerates that much venom that quickly.
Student #1: We're supposed to know how fast snakes make their venom?
House: Nope. Unless you've got a patient who has been bit by one. Then it might be helpful. So what do we do now?
Student #2: He must have been bitten by a different snake. We go back and find it.
House: Or you go online and find there's only three poisonous snakes in New Jersey: the copperhead, the timber rattler, and the coral. The copperhead and the timber rattler both respond to the antivenoms we gave the guy.
Student #2: So we give him the antivenom for the other one.
House: Is that a question?
Student #1: Well, we can't just blindly give him another antivenom. Especially after the first one almost killed him. You said only three types of poisonous snakes commonly found in New Jersey. But what if this is an uncommon one?
House: Very good.
Student #1: We've gotta find the right snake.
House: No need. Odds are, by the time you get back the autopsy results will tell you what kind of snake it was. Who gives the guy the other antivenom? And who goes looking for the snake? (To each question, half the class raise their hands)
Student #3: I assume that one choice kills him and one saves him.
House: That's usually the way it works at the leg turning black stage.
Student #2: So half of us killed him and half of us saved his life.
House: Yeah.
Student #1: But we can't be blamed for---
House: 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.

House: How do they teach you how to tell someone that they're dying? It's kind of like teaching architects how to explain why their building fell down. Do you roleplay and stuff?
Student #1: Yeah, one of us gives the bad news and one of us gets the bad news.
House: And what do you have to do to get an A in You're Dying 101? They grade you on gentleness and supportiveness? Is there a scale for measuring compassion? This buddy of mine, I gotta give him ten bucks every time somebody says 'Thank you'. Imagine that. This guy's so good, people thank him for telling them that they're dying.... I don't get thanked that often.... It's a basic truth of the human condition that everybody lies. The only variable is about what. The weird thing about telling someone they're dying is it tends to focus their priorities. You find out what matters to them. What they're willing to die for. What they're willing to lie for.

House: The patient was technically dead for over a minute....
Wilson: Do you think he was dead? Do you think those experiences were real?
House: Define real. They were real experiences. What they meant, personally, I choose to believe that the white light people sometimes see, visions, this patient saw: they're all just chemical reactions that take place when the brain shuts down.
Foreman: You choose to believe that?
House: There's no conclusive science. My choice has no practical relevance to my life, I choose the outcome I find more comforting.
Cameron: You find it more comforting to believe that this is it?
House: I find it more comforting to believe that this isn't simply a test.

House: I asked what you would do. It seems unfair for you to ask me what you would do.

Stacy Warner: I know you're not too busy. You avoid work like the plague. Unless it actually is the plague. I'm asking you a favor.
House: I'm not too busy. But I'm not sure I want him to live. It's good seeing you again.

House: And (C.), we've got Carmen Electra golfing.
Carmen Electra: (Makes a mini-golf shot.) Yes!
Keen Student: Whoa, whoa. Y-you treated the Baywatch chick?
House: The Baywatch thespian. And no. I gotta disguise the identity of each of the patients, and I got tired of using the middle-aged man. Carmen seemed like a pleasant alternative. Also, she's apparently quite the golfer.
Keen Student: Well, obviously we should care about all our patients, no matter what age....
House: Yeah, right. I saw the way you were looking at Carmen. She's mine. Stay away.

Cameron: I went back three generations. No history of cancer, Parkinson's or any other degenerative condition. But there's this boy at school, and he's on the boys' volleyball team, and they made out at a party, and now he won't call her back, and this friend of hers at school said this boy didn't like her and never did.
House: You got all this from an examination of the knee?
Cameron: I think she's depressed.

Wilson: You think this is easy for her? The only reason she'd be anywhere near you is if she was desperate.
House: So I should help her because she hates me?
Wilson: She doesn't hate you. She loves you. She just... can't... stand to... be around you.

House: On average, drug addicts are stupid. *pops a Vicodin*

House: Patient made the right choice. Tell a surgeon that it's okay to cut a leg off, and he's gonna spend the night polishing his good hacksaw.

Bobbin Bergstrom sightingEdit

She is the nurse who assists Cameron when The Farmer suffers the allergic reaction to the anti-venom.

LinksEdit


Previous episode:
Damned If You Do

Three Stories
Next episode:
Honeymoon
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