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Vince came to the hospital with the feeling that his hands were on fire. At the emergency room, his case was given to Dr. Hadley who ruled out carpal tunnel syndrome and trauma, and did a full battery of blood tests that turned out normal. Dr. Hadley recommended a neurology consult, but the patient had heard of Dr. House. Unfortunately, due to a suspension of his medical license, he was unavailable.
Instead, the case was assigned to the new head of diagnostic medicine, Dr. Foreman. He started a differential with Dr. Hadley and Dr. Taub. Dr. Taub suggested diabetic neuropathy, but the patient’s HbA1c looked fine. Dr. Foreman suggested hypothyroidism, but there was no fatigue or weight gain. Dr. Hadley suggested complex regional pain syndrome and Dr. Foreman agreed and ordered treatment with spinal stimulation.
However, the patient disagreed. He had been doing research on the internet and thought it might be mercury poisoning. Dr. Hadley said it was unlikely he could get it just by consuming with a lot of fish, and that it usually presented with symptoms in addition to pain. The patient countered that CRPS usually presented with skin discoloration and constant pain, not intermittent pain. He asked them merely to test his blood for mercury.
However, Dr. Foreman found out the others had delayed the spinal stimulation and went to confront them. Dr. Hadley said they had agreed to test the patient for mercury even though it was unlikely. Dr. Foreman admonished them for not informing him. The test for mercury was negative, showing a level of 2.8.
Dr. Foreman went to speak to Vince. Vince asked what his level was. He realized it was above normal and asked for chelation therapy. He refused spinal stimulation. At that point, Dr. Foreman told him he was willing to withdraw from the case and assign him another doctor who would do all the tests the patient wanted. The patient finally consented.
Dr. Taub and Dr. Hadley performed the procedure. However, Vince complained that he had pain in his chest. Vince’s heart rate rose to 140 bpm and continued to climb as he had difficulty breathing. Dr. Hadley asked him to hold still and Dr. Taub administered oxygen. Dr. Hadley realized Vince’s lungs were filling with fluid.
The tests on the fluid from Vince’s lung showed that the problem was with his heart - a thickened left ventricle. The rise in his heart rate during the procedure forced the fluids into his lungs resulting in pulmonary edema. Although this ruled out CRPS, they would not have seen the new symptom if they had not performed the procedure. The two symptoms suggested Lyme disease, but there was no joint pain. Dr. Foreman wondered when the patient’s next game was coming out and surmised that he might be using stimulants. Cocaine use would explain both symptoms. Dr. Hadley wanted to do an environmental scan, but Dr. Foreman wanted to ask the patient first.
Dr. Foreman apologized to the patient, but the patient had hacked into Dr. Foreman’s social media profile and found a picture of him with Dr. Hadley. He also denied using cocaine for the past 12 years. Dr. Foreman ordered Dr. Hadley to do an environmental scan of the patient’s office and talk to his co-workers.
Dr. Taub and Dr. Hadley took the opportunity to try out the patient’s new video game and looking at the realism of the birds led Dr. Hadley to the idea that the patient had worked with real birds and had contracted psittacosis. When they went to the patient, he asked if that could cause a three hour erection. This ruled out psittacosis.
The erection persisted even on medication and they had to insert a surgical shunt to drain the blood. Dr. Taub thought it might be Guillain-Barre syndrome, but the patient’s nerve conduction was normal. Dr. Foreman suggested thrombocytosis, but his platelet count was only slightly elevated. Dr. Hadley suggested a brain tumor. However, Dr. Taub agreed with Dr. Foreman that it was a circulatory problem and Dr. Foreman decided on treatment for thrombocytosis - hydroxyurea.
However, Dr. Foreman soon found out that the patient had contacted other physicians, two of whom had come to see him. Dr. Foreman dismissed them for not having hospital privileges. However, Dr. Paulson also suggested a brain tumor and head MRI. Dr. Foreman pointed out there were no signs of elevated ICP. The patient asked for Dr. Hadley’s opinion and she said both theories had merit. The patient figured that she also thought it was a brain tumor and asked for an MRI. Dr. Foreman agreed.
However, the MRI was clean. Dr. Foreman ordered treatment for thrombocytosis. He admonished Dr. Hadley for not backing him with the patient.
However, the treatment didn’t have any effect on his symptoms and Vince’s lymph nodes started to swell excessively. The patient once again posted his symptoms on the internet and offered a $25,000 reward. Steroids were administered, which lessened the facial swelling. The team was inundated with faxes and telephone calls. Dr. Foreman suggested that lymph node involvement pointed to polyarteritis.
However, first Dr. Foreman confronted the patient with the faxed diagnoses. Paraneoplastic syndrome from a spinal tumor was ruled out as there was no hypocalcaemia, muscle spasms or incontinence. Grave’s disease was ruled out as his thyroid levels were normal. The patient still wanted to be tested for amyloidosis because it was the most common diagnosis. However, Dr. Foreman pointed out there was no speckling on his cardiac ultrasound. The patient countered that it doesn’t always occur. Dr. Foreman agreed to a kidney biopsy on the condition that if it came back negative he would take his case off the internet and retract the reward. The patient agreed.
However, the biopsy was consistent with amyloidosis. Dr. Taub had already started the patient on dexamethasone. Dr. Taub left the case to pursue other opportunities.
However, the next morning when Dr. Hadley went to check in on the patient, he was not in his room. Dr. Foreman found him in the lobby having hallucinations. The patient threw a soft drink at Dr. Foreman, but Dr. Hadley and Dr. Foreman managed to restrain him and calm him down. However, Vince was soon hallucinating again. Dr. Foreman realized he was hallucinating from a high fever, which wouldn’t be caused by amyloidosis.
The team tried anti-pyretics, but they had no effect. Vince was put in a cold bath to try to lower his body temperature. Dr. Hadley wanted to check the internet responses, but Dr. Foreman thought it was Light-Chain Deposition Disorder. Dr. Foreman went to the patient, who was now lucid. He told Vince that there was no test to confirm the disorder, and the only treatment was high dose chemotherapy, which was dangerous in his condition. The patient agreed to treatment.
However, shortly after, Dr. Foreman had a shower and noticed that his fingertips were swollen. He realized that although Vince had been soaking in a tub, his fingertips weren’t swollen. He realized Vince had Fabry disease. He rushed to Dr. Hadley to tell her to stop the chemotherapy, but she had checked the internet responses and had also found one that mentioned Fabry disease. She already confirmed Fabry and had discontinued chemotherapy. The biopsy had shown fat which had been mistaken for amyloid proteins. Fabry makes fat clog tissues. It was chronic, but manageable. Dr. Hadley had realized that the swollen lymph nodes were merely iodine mumps, a reaction to the contrast material for the MRI. With that information, she reviewed the online responses for something that fit without the lymph node swelling.
At the beginning of Epic Fail, we see Vince and his team working on a video game that is set to be released. This game becomes popular among House and his team, and is seen in multiple episodes later in the series. During development, players use a heads-up display, but after release it is only seen being played on a television. The game uses wireless controllers, but it is unknown what system platform it was designed for.
- When investigating Vince's office, Taub and Thirteen play the game, but Thirteen seems much better at playing it (whereas Taub ends up flailing on the floor to ward off virtual bats).
- At the beginning of Massage Therapy, House is playing the game in bed when Cuddy (who says her wrists are tired) is getting ready to leave.
- Taub and Foreman play the game together at Foreman's apartment while Foreman is helping Taub study for his pathology exam in You Must Remember This. At the end of the episode, after Taub gives his television to Foreman for Foreman's living room, Foreman calls the game "Savageskape" (spelled "Savageskate" in Netflix subtitles) while offering to let Taub live with him. In Recession Proof, Taub loses on purpose to cheer up Foreman. In the next episode, Bombshells, Foreman returns home to find House playing the game, and Foreman calls it Savageskape 2: The Revenge.