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Under My Skin

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Under My Skin
House 504a
Director(s)
Airdate
May 4, 2009
Episode Number
5.23
TV.com Rating
9.0/10
Guest Star(s)
Final Diagnosis
Gonorrhea complicated by sepsis
Zebra Factor
1/10
"See, the problem with speculation is you make a speck out of you and some guy named Lation."
―Under My Skin

Under My Skin is a 5th season episode of House which first aired on May 4, 2009. House and the team take on the case of a ballerina (guest star Jamie Tisdale) whose lungs collapse in the middle of a rehearsal. When the treatment causes her skin to fall off, the dancer faces not only the prospect of never dancing again but also the risk of dying an agonizing death. The team must use their imaginations to carefully choreograph ways to test and treat her delicate body without killing her or destroying her future as a dancer. Meanwhile, House continues to suffer from what he thinks is insomnia, and he is willing to go to desperate measures to cure it. Upon realizing that his Vicodin addiction may be what's causing his hallucinations, he asks Cuddy to help him go through the painful detox. The experience leads the two to end up kissing passionately as the episode comes to a close.

This episode finished 5th in Facebook's poll of the best episodes of the series completed in April, 2012.


RecapEdit

A ballet dancer's back goes out during a lift and he drops the ballerina. Suddenly, she can't breathe.

House is at home listening to the Amber hallucination play the ukelele. He accuses her of trying to kill Chase and she says it must have been his idea. There is a knock at the door - it's Foreman telling him they have a case. House wants to take a personal day, but Foreman tells him Cuddy will fire him.

The team describes the case and the lack of obvious problems with the lungs. House starts disagreeing with “Amber” deliberately. However, he finally gives in and suggests the dehydration from the exertion of ballet is hiding pneumonia. He orders fluids and antibiotics.

Wilson is telling a patient he has kidney cancer when House bursts in. Wilson tries to get rid of him but House admits he is having hallucinations. Wilson asks if he has any other symptoms and tells him he shouldn't be practicing. House admits he is talking to the hallucination, and tries to convince Wilson he sees Kutner. Wilson agrees to sit in on the differential diagnosis.

Chase and Cameron are having dinner at home when she blurts out she saved her dead husband's sperm. Now she wants to keep it. Chase sees it as a backup plan if their relationship ends.

Wilson is trying to tell House his hallucinations might not be sleep apnea, but House blows him off and sends Wilson out of the sleep lab. However, Amber is still there the next morning. Foreman comes in to say the patient hasn't improved and they can’t to a bronch so House suggests the equivalent of waterboarding to test her lungs. Foreman objects, but House says to do it or come up with a better diagnosis. House then hands Wilson a list of possible diagnoses for his insomnia and hallucinations. They decide to test for infections. Amber reminds him that infection is the only treatable condition on the list.

They explain the procedure to the patient, who is terrified. They perform a tracheotomy to add liquid to her lungs and when Taub goes to hold her he notes that her skin has come away.

They start performing skin grafts as the patient is losing her skin rapidly. House wants to do an ultrasound and puts the skin loss down to the antibiotics they gave her.

House tells Wilson the patient has toxic epidermal necrolysis. Wilson tells him not to blame himself, but Amber reminds him he's not like other doctors and shouldn't have made the mistake. House suggests that he should apologize to the patient to see his own reaction to see if he has suffered brain damage. He goes to see the patient. They have found what appears to be liver cancer, but she's more worried about dancing again. Amber wants House to mock her, but instead House tells her it's his fault for giving her antibiotics before confirming an infection and apologizes. The patient and her boyfriend thank him, but he realizes he’s not feeling an emotional reaction.

House wonders if a biopsy has been done to confirm cancer, but her skin is too weak to do one - she would bleed from the biopsy site. House tells them to come into the liver through the hepatic vein so she will bleed back into her bloodstream. Foreman notices that House appears to be checking with Wilson on every decision, but House denies it. He tells Wilson that he felt nothing when he apologized to the patient - he thinks he is suffering from multiple sclerosis. Wilson suggests a lumbar puncture to confirm.

Foreman and Chase do the biopsy. They discuss Cameron keeping her dead husband's sperm. Foreman tells him to agree to let her keep it because otherwise he can never leave Cameron, ever, for any reason. Suddenly the patient starts to crash.

However, the liver biopsy is negative for cancer. They start a new differential, and Foreman wonders why Wilson is sticking around. He figures out that House wants Wilson there to make sure he doesn't screw up. House throws out Wilson. Amber tells House that he doesn't have multiple sclerosis, but that leaves only Vicodin and severe mental illness as possible diagnoses - either way, he can‘t practice medicine any more. She then stabs herself in the forearm. Suddenly, House suggests inducing a cardiac arrest on the patient so they can get a proper MRI, even though they will only have three minutes.

House lets it slip to Wilson that a female is the hallucination and finally admits to Wilson that it's Amber. Wilson says his plan to stop the patient’s heart is crazy, but not too crazy. Wilson confirms that he doesn't have multiple sclerosis as the LP was negative, but tells him his Vicodin levels are too high. House wants to try electroshock therapy, but Wilson dissuades him because of the possibility of damaging his mind.

The team induces a cardiac arrest to do the MRI.

House calls Wilson to suggest he try insulin shock therapy to deal with the mental illness and hallucinations. He tells Wilson to get up there right away because he's going to try it anyway.

The team starts to find something, but it's clear they have to restart the patient's heart so they stop the scan. They go over three minutes, but keep trying to resuscitate the patient.

House injects himself with insulin. As the insulin takes hold, Amber starts to disappear. He collapses on the floor with a seizure as Wilson arrives and calls for glucose.

House regains consciousness as Wilson stands over him. He reminds House he could have died, but Amber appears to have disappeared. House thinks he is all better, but Wilson examines him anyway. Wilson can't find anything wrong and releases him.

They tell House that they saw a shadow on her heart, but Chase says he had to interrupt the MRI. When House says that they must have had more time as the patient had no brain damages, Chase storms out. However, the shadow could be anything and any test they could run would be dangerous. House goes to see the patient and notices the boyfriend is too devoted. He thinks it might be gonorrhea in an abcess in her heart which wouldn't show up in a blood test for the disease. They decide to check the boyfriend and do surgery on the patient to remove the abcess if he tests positive.

House goes for a celebration dinner but he gets a phone call. The boyfriend has gonorrhea but denies having sex with anyone other than the patient. Foreman tells him they are prepping the patient for surgery. He also points out that the boyfriend probably got the gonorrhea from the patient because he‘s left. House realizes he was just lucky - the boyfriend wasn't showing guilt. Suddenly, he sees Amber again. He calls Wilson to come and pick him up.

Wilson suggests a rehab facility. They go back to House's place to pack when House gets another phone call. Foreman tells Wilson the patient is septic and they can‘t operate, but Wilson tells Foreman House is off the case. Wilson tells House the patient is fine, but Amber knows Wilson is lying. However, House realizes rehab won't work - he will cheat as usual.

The team discusses what they can do about the sepsis but everything they suggest won't work. They decide to try dopamine to keep her blood vessels closed despite the risks.

House shows up at Cuddy's office and tells her he's going to quit. Cuddy asks him what he really wants. House insults Cuddy’s daughter and she goes to leave, but House finally admits he's hallucinating because of the Vicodin. He asks Cuddy to oversee his detox personally - otherwise he will scam someone. Cuddy calls to arrange a babysitter for her daughter.

They take the patient to surgery as Chase goes to remove the abcess. The patient's blood pressure is holding despite the prediction that it won't, but they notice that the patient is losing blood flow to her extremities.

Cuddy is dealing with House's withdrawal symptoms. When she goes to make tea, he catches himself looking for drugs. However, Cuddy has beat him to them. House starts to tell Cuddy about where he has hidden his stashes even though Amber is telling him not to.

They take the patient to recovery and tell her that they removed the abcess but they have to amputate her hands and feet or else gangrene will set in. However, she refuses consent. Foreman wants to quit, but Taub wants to keep working.

House is staring to improve, but sees some Vicodin. Amber tells him to send Cuddy away. Cuddy leaves and House tries to get the pill that is on the bathroom floor. However, Cuddy beats him to it and flushes it down the toilet. House unsuccessfully tries to retrieve it.

Taub tries vasodilators to restore circulation to the extremities. Incredibly, it starts to work.

House continues to improve, but he's afraid he won't be able to work because of the pain in his leg. However, Cuddy reminds him that the opiates may actually have made him think he was in more pain than he was. Cuddy reminds him that she hasn't lied to him in 20 years, but that just makes House want to know what she did lie to him about 20 years ago. She finally tells him that he wasn't really in his endocrinology class - she was just auditing. She was there to be closer to House. House realizes Amber is gone.

The patient wakes up and realizes her hands and feet are still there. She wants to know where her boyfriend is, but Taub tells her he left.

Chase tells Cameron the patient recovered. However, he also tells her that he can't let her keep her dead husband's sperm. He tells her he has no doubts about being with her, but she thinks he's being naive. He tells her he will wait until she's sure too.

Cuddy goes to leave and realizes House wants to kiss her. He admits he always wants to kiss her, and they kiss passionately and start undressing.

Major Events Edit

  • We find out that Cameron has been keeping her deceased husband's sperm
  • In an attempt to get rid of Amber once and for all, House injects himself with insulin and begins having seizures.
  • After undergoing a very painful detox from Vicodin, House and Cuddy kiss passionately.

Zebra Factor 1/10 Edit

Gonorrhea is still a common infection despite the development of antibiotics and moves towards safer sex. Abcesses are also common. Sepsis is less common, but not overly so. The only rare thing in this episode was the toxic reaction to the antibiotics, which is a very rare complication.

Trivia & Cultural References Edit

  • The title for this episode comes from the song "I've Got You Under My Skin", written by Cole Porter. It may refer to one or more of the following events within the episode:
    • House realizes that the Amber hallucination is beginning to control him, causing him to seek detox.
    • Chase realizes that Cameron's dead ex-husband's sperm is getting to him, causing him to confront her about it.
    • The patient loses 80% of their skin following a rare side-effect of the antibiotics.
  • More about Ballet.
  • At the beginning of the episode, Amber plays a Ukulele, a stringed instrument developed in Hawaii that copied an instrument used by Portuguese immigrants. It soon developed a following of its own worldwide.
  • Amber is playing Yankee Doodle on her ukulele, a song with both English and American origins. It was initially used by the British to mock Americans but during the American Revolutionary War the American side turned it into a patriotic song to band together.
  • Amber Hallucination tells House that she and House are "Like Magic and Kareem". Earvin "Magic" Johnson and Kareem Abdul-Jabbar were two basketball players from the 80s. The duo played together for 10 seasons and won LA Lakers 5 NBA championships.
  • House’s attempt to break down “Speculation” is a play on the old joke that “Assume” makes an “Ass” out of “U” and “me”.
  • House is still using MMMBop as the ringtone for his team.
  • Amber’s last song is Enjoy Yourself (It’s Later Than You Think) which was first published and recorded in 1949.
  • Chase restarts the patient's heart using a defibrillator, after Thirteen stated that the patient had "flatlined".. This common trope reoccurs in several episodes of House.

CastEdit

End Credits MessageEdit

Male Announcer: A man with a few hours left to win, and there's nothing left to lose. 24 is next.

LinksEdit


Previous episode:
House Divided

Under My Skin
Next episode:
Both Sides Now

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